Author + information
- Young-Ji Seo1,
- Aditya Mantha2,
- Katherine Bailey1,
- Esteban Aguayo3,
- Vishal Dobaria4,
- Yen-Yi Juo5,
- Peyman Benharash5 and
- Ramin Ebrahimi6
- 1David Geffen School of Medicine at UCLA, Los Angeles, California, United States
- 2University of California Irvine, Orange, California, United States
- 3UCLA/CDU School of Medicine, Los Angeles, California, United States
- 4UCLA, Los Angeles, California, United States
- 5David Geffen School of Medicine at UCLA, LOS ANGELES, California, United States
- 6David Geffen School of Medicine UCLA & Veteran's Administration, Los Angeles, California, United States
Rheumatoid arthritis (RA) is associated with increased incidence and severity of adverse outcomes following acute coronary syndromes. Invasive strategy results in lower mortality and complication rates. However, the impact of RA on treatment choice for NSTEMI patients remains ill-defined. The present study was performed to better evaluate the impact of invasive vs conservative strategy in NSTEMI patients with RA.
From 2010-2014, patients diagnosed with RA and NSTEMI in the National Readmission Database were identified. Invasive strategy was defined as cardiac catheterization, percutaneous coronary intervention, or coronary artery bypass grafting. The NRD is an all-payer inpatient database maintained by the Healthcare Cost and Utilization Project (HCUP) that estimates more than 35 million annual U.S. hospitalizations. Mortality, readmission, and GDP-adjusted cost were evaluated using hierarchical linear models adjusting for socioeconomic, demographic, and comorbidity measured by Elixhauser Index.
Of the 15,652 patients diagnosed with RA and NSTEMI during the study period, 6,690 (43%) patients received an invasive approach. Patients treated with an invasive approach were more likely to be female (56% vs 44%, p<0.001), younger (68 vs. 74, p<0.001), and had less severe comorbidities based on the Elixhauser Index (4.5 vs. 5.4, p<0.001). The invasive approach was associated with lower risk-adjusted in-hospital mortality (2 vs. 6%, OR=0.43, p<0.001), lower adjusted cost (β=0.92, p<0.001), and longer hospitalization (5.9 days vs. 5.3 days, p<0.001). Revascularization was associated with lower adjusted risk of readmission at 6-months (OR=0.84, p<0.002). All-cause readmission at 30 days (18% vs 20%, OR=0.93, p=NS) and cost of care at 30-day and were not significantly different between treatment modalities.
In patients with RA presenting with NSTEMI, invasive strategy compared to conservative management results in improved mortality, lower cost and lower odds of readmission within 6 months. Given the limitations of national large databases, our findings warrant further investigation of invasive vs conservative approaches in RA patients presenting with NSTEMI.
CORONARY: Acute Coronary Syndromes