Post-MI Prognosis Worse With IBD

Published: Oct 15, 2014

By Nancy Walsh, Senior Staff Writer, MedPage Today

save

|

A

A

Patients with active inflammatory bowel disease (IBD) were at risk for poor outcomes after a first myocardial infarction (MI), a Danish cohort study found.

Compared with patients without IBD, the odds ratio for mortality during hospitalization for MI or within a month of discharge was 3.29 (95% CI 1.98-5.45) for patients with IBD experiencing a flare, and 1.62 (95% CI 0.95-2.77) for those with persistent disease, according toSoren Lund Kristensen, MD, PhD, of Copenhagen University Hospital in Hellerup, and colleagues.

In contrast, IBD patients who were in remission at the time of MI had no greater mortality risk than non-IBD patients (OR 0.97, 95% CI 0.78-1.19), the researchers reported online in Circulation: Cardiovascular Quality and Outcomes.

Chronic inflammation underlies both IBD and atherosclerosis, and recent studies have linked IBD with new onset cardiovascular disease and atherothrombotic events, but little is known about subsequent prognosis.

"No previous studies of post-MI prognosis in patients with IBD have been reported, but the association between IBD and worsened prognosis after MI is in line with findings in other chronic inflammatory diseases, including rheumatoid arthritis and psoriasis," Kristensen and colleagues wrote.

To examine post-MI prognosis in patients with IBD -- and the possibility that disease activity might influence outcome -- the researchers analyzed data from the Danish National Patient Registry for all patients hospitalized with a first MI between 2002 and 2011, as well as for previous hospitalizations for ulcerative colitis or Crohn's disease. Mean follow-up was 3.9 years.

In the IBD group, flare was defined as disease activity lasting up to 120 days after a period of remission, and persistent disease was activity continuing beyond that point.

During the study period, there were 1,030 hospitalizations for first-time MI among patients with IBD and 85,760 among non-IBD individuals.

In-hospital and 30-day mortality occurred in 16.2% of IBD patients and in 15.4% of the non-IBD population.

Deaths in the IBD group occurred in 28.2% of those with flares, 21.3% of those with persistent disease, and 14.1% of those in remission.

Incidence rates for recurrent MI were 3.3 per 100 patient-years in the IBD group and 2.7 in the non-IBD patients.

A significant increase for recurrent MI was observed in patients with disease flares (hazard ratio 3.09, 95% CI 1.79-5.32) and for those with persistent disease (HR 1.98, 95% CI 1.09-3.61), though not for those in remission (HR 1.03, 95% CI 0.81-1.31), the researchers reported.

On a composite endpoint of recurrent MI, stroke, or cardiovascular death, risk was higher during flares (HR 2.04, 95% CI 1.35-3.06) and periods of persistent disease (HR 1.73, 95% CI 1.19-2.50), though not during periods of remission (HR 1.06, 95% CI 0.91-1.23).

Similarly, for all-cause mortality, risk was twice as high during flares (HR 2.25, 95% CI 1.61-3.15) and with persistent disease activity (HR 2.04, 95% CI 1.53-2.73), but not with remission (HR 0.95, 95% CI 0.83-1.10).

The finding that active IBD is associated with cardiovascular outcomes further supports the concept that inflammation underlies both disease processes. "Indeed, the arterial and systemic immune-inflammatory processes implicated in atherosclerosis and atherothrombotic events bear many resemblances to the intestinal and systemic inflammation seen in active IBD," the authors noted.

These similarities include increases in C-reactive protein and local appearance of cells from both the adaptive and innate immune systems.

"The results support evidence indicating that increased clinical surveillance and treatment aimed at reduction of cardiovascular risk by reducing length and number of flares in patients with IBD may be warranted, especially for patients with prolonged or repeated disease activity," Kristensen and colleagues concluded.

Limitations included the study's observational design and reliance on hospital admission data to determine IBD activity.