Prognosis After First-Time Myocardial Infarction in Patients With Inflammatory Bowel Disease According to Disease Activity: Nationwide Cohort Study

TY - JOUR

T1 - Prognosis After First-Time Myocardial Infarction in Patients With Inflammatory Bowel Disease According to Disease Activity

T2 - Nationwide Cohort Study

AU - Kristensen, Søren Lund

AU - Ahlehoff, Ole

AU - Lindhardsen, Jesper

AU - Erichsen, Rune

AU - Lamberts, Morten

AU - Khalid, Usman

AU - Nielsen, Ole Haagen

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar Hilmar

AU - Hansen, Peter Riis

N1 - © 2014 American Heart Association, Inc.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - BACKGROUND: Inflammatory bowel disease (IBD) is associated with increased cardiovascular risk. We examined the effect of active IBD on major adverse cardiovascular outcomes after myocardial infarction (MI).METHODS AND RESULTS: In nationwide registries, we identified 86 790 patients with first-time MI from the period 2002 to 2011. A total of 1030 patients had IBD, and we categorized their disease activity stages into either flare (120 days), persistent (>120 days) activity, or remission. Short-term mortality was estimated in a logistic regression-model, whereas risk of recurrent MI, all-cause mortality, and a composite of recurrent MI, cardiovascular death, and stroke were estimated by Cox regression-models. Odds ratio of death during hospitalization or within 30 days of discharge (n=13 339) corresponded to 3.29 (95% confidence interval [CI], 1.98-5.45) for patients in IBD flares, 1.62 (95% CI, 0.95-2.77) for persistent activity, and 0.97 (95% CI, 0.78-1.19) for remission when compared with the non-IBD group. Among 73 451 patients, including 863 with IBD, alive 30 days after discharge, IBD was associated with hazard ratios of 1.21 (95% CI, 0.99-1.49) for recurrent MI, 1.14 (95% CI, 1.01-1.28) for all-cause mortality, and 1.17 (95% CI, 1.03-1.34) for the composite end point. When compared with the non-IBD group, IBD flares, in particular, were associated with increased risks of recurrent MI (hazard ratio, 3.09; 95% CI, 1.79-5.32), all-cause mortality (hazard ratio, 2.25; 95% CI, 1.61-3.15), and the composite end point (hazard ratio, 2.04; 95% CI, 1.35-3.06), whereas no increased risk was identified in remission.CONCLUSIONS: Active inflammatory bowel disease worsens prognosis after MI, in particular, in relation with flares.

AB - BACKGROUND: Inflammatory bowel disease (IBD) is associated with increased cardiovascular risk. We examined the effect of active IBD on major adverse cardiovascular outcomes after myocardial infarction (MI).METHODS AND RESULTS: In nationwide registries, we identified 86 790 patients with first-time MI from the period 2002 to 2011. A total of 1030 patients had IBD, and we categorized their disease activity stages into either flare (120 days), persistent (>120 days) activity, or remission. Short-term mortality was estimated in a logistic regression-model, whereas risk of recurrent MI, all-cause mortality, and a composite of recurrent MI, cardiovascular death, and stroke were estimated by Cox regression-models. Odds ratio of death during hospitalization or within 30 days of discharge (n=13 339) corresponded to 3.29 (95% confidence interval [CI], 1.98-5.45) for patients in IBD flares, 1.62 (95% CI, 0.95-2.77) for persistent activity, and 0.97 (95% CI, 0.78-1.19) for remission when compared with the non-IBD group. Among 73 451 patients, including 863 with IBD, alive 30 days after discharge, IBD was associated with hazard ratios of 1.21 (95% CI, 0.99-1.49) for recurrent MI, 1.14 (95% CI, 1.01-1.28) for all-cause mortality, and 1.17 (95% CI, 1.03-1.34) for the composite end point. When compared with the non-IBD group, IBD flares, in particular, were associated with increased risks of recurrent MI (hazard ratio, 3.09; 95% CI, 1.79-5.32), all-cause mortality (hazard ratio, 2.25; 95% CI, 1.61-3.15), and the composite end point (hazard ratio, 2.04; 95% CI, 1.35-3.06), whereas no increased risk was identified in remission.CONCLUSIONS: Active inflammatory bowel disease worsens prognosis after MI, in particular, in relation with flares.

U2 - 10.1161/circoutcomes.114.000918

DO - 10.1161/circoutcomes.114.000918

M3 - Journal article

C2 - 25316773

SN - 1941-7713

VL - 7

SP - 857

EP - 862

JO - Circulation. Cardiovascular Quality and Outcomes (Print)

JF - Circulation. Cardiovascular Quality and Outcomes (Print)

IS - 6

ER -