Characteristics and outcome of a first acute myocardial infarction in patients with ankylosing spondylitis
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ORIGINAL ARTICLE
Characteristics and outcome of a first acute myocardial infarction in patients with ankylosing spondylitis Anna Södergren 1,2 & Johan Askling 3 & Karin Bengtsson 4 & Helena Forsblad-d’Elia 1 & Tomas Jernberg 5 & Ulf Lindström 4 & Lotta Ljung 1,3 & Ängla Mantel 3 & Lennart T. H. Jacobsson 4 Received: 13 June 2020 / Revised: 13 August 2020 / Accepted: 18 August 2020 # The Author(s) 2020
Abstract Objectives To study clinical characteristics, mortality, and secondary prevention, after a first incident acute myocardial infarction (AMI) in patients with ankylosing spondylitis (AS) compared with the general population. Methods In total, 292 subjects with AS and a first AMI between Jan 2006 and Dec 2014 were identified using the Swedish national patient register. Each subject was matched with up to 5 general population comparators per AS-patient (n = 1276). Follow-up started at the date of admission for AMI and extended until death or 365 days of follow-up. Cox regression was used to assess mortality in two time intervals: days 0–30 and days 31–365. For a subgroup with available data, clinical presentation at admission, course, treatment for AMI, and secondary prevention were compared. Results During the 365-day follow-up, 56/292 (19%) AS patients and 184/1276 (14%) comparators died. There were no difference in mortality due to cardiovascular-related causes, although the overall mortality day 31–365 was increased among patients with AS compared with comparators (HR [95% CI] = 2.0 [1.3;3.0]). At admission, AS patients had a higher prevalence of cardiovascular comorbidities compared with comparators. At discharge, patients with AS were less often prescribed lipidlowering drugs and non-aspirin antiplatelet therapy. Conclusions Patients with AS tend to have a higher comorbidity burden at admission for first AMI. The mortality after a first AMI due to cardiovascular-related causes does not seem to be elevated, despite an increased overall mortality during days 31– 365 among patients with AS compared with the general population.
Key Points • The all-cause mortality after a first AMI was higher in patients with AS. • Mortality after a first AMI due to CVD-related causes does not seem to be elevated for patients with AS. • In patients with AS suffering a first AMI, more attention should be given to other comorbidities causing an excess in mortality.
Keywords Acute myocardial infarction . Ankylosing spondylitis . Cardiovascular disease . Mortality
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05354-3) contains supplementary material, which is available to authorized users. * Anna Södergren [email protected] 1
Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
2
Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
3
Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
4
Department of Rheumatology and Inflammation Research, Sah
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