Pos0443 clinical outcomes of elderly patients with rheumatoid arthritis who underwent percutaneous coronary intervention: a nationwide cohort study

Background Rheumatoid arthritis (RA), a systemic inflammatory arthritis, is associated with an increased risk of cardiovascular disease. Despite an increased proportion of elderly patients with RA and an increased prevalence of patients with RA undergoing percutaneous coronary intervention (PCI), studies on the PCI outcomes in elderly patients with RA are limited and controversial. Objectives This study aimed to evaluate the prognosis of elderly patients with and without RA who underwent PCI and the risk factors associated with the prognosis. Methods The Korean National Health Insurance Service claims database was used to extract data on 74623 patients (14,074 patients with RA and 60,549 patients without RA) aged 65 years or older who were diagnosed with acute coronary syndrome and underwent PCI between 2008 and 2019. The primary outcome was all-cause mortality between elderly patients with and without RA. The secondary outcome was all-cause mortality in elderly patients with RA who consist of patients with elderly onset RA that manifests after the age of 65 years and elderly patients who presented with young onset RA earlier in life. Results During a 10-year follow-up, the survival rate was lower in patients with RA than in those without RA (with RA: 53.7% vs. without RA: 58.3%, log-rank P <0.001). Compared to patients without RA, patients with elderly onset RA have poor survival outcomes and patients with young onset RA have good survival outcomes (with elderly onset RA: 48.1% vs. with young onset RA: 73.7% vs. without RA: 58.3%, log-rank P <0.001). Multivariable logistic regression analyses showed that diabetes mellitus (hazard ratio (HR) 1.39, 95% confidence intervals (CI) 1.35-1.43, P <0.001), chronic kidney disease (HR=3.97, 95% CI 3.63-4.34, P <0.001), and PCI due to myocardial infarction (HR=1.35, 95% CI 1.33-1.37, P <0.001) were the independent risk factors for all-cause mortality. Conclusion Elderly patients with RA who underwent PCI for acute coronary syndrome have an increased rate of all-cause mortality compared to general elderly patients. Among elderly patients with RA, patients with elderly onset RA particularly have poor survival outcomes. Based on the aspects of RA and cardiovascular disease in elderly patients, the clinical practice should focus on more detailed and active secondary prevention methods for a better prognosis. References [1]Peters MJL, van Halm VP, Voskuyl AE, Smulders YM, Boers M, Lems WF, et al. Does rheumatoid arthritis equal diabetes mellitus as an independent risk factors for cardiovascular disease? A prospective study. Arthritis & Rheumatism 2009;61:1571-79. [2]Nochioka K, Biering-Sorensen T, Hansen KW, Sorensen R, Pedersen S, Jorgensen PG, et al. Long-term outcomes in patients with rheumatologic disorders undergoing percutaneous coronary intervention: a BAsel Stent Kosten-Effektivitats Trial-Prospective Validation Examination sub-study. Eur Heart J Acute Cardiovasc Care 2017;6:778-86. [3]Martinez SC, Mohamed M, Potts J, Abhishek A, Roddy E, Savage M, et al. Percutaneous coronary intervention outcomes in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Rheumatology 2020;59:2512-22. [4]Serhal L, Lwin MN, Holroyd C, Edwards CJ. Rheumatoid arthritis in the elderly: characteristics and treatment considerations. Autoimmun Rev 2020;19:102528. Figure 1. Survival rates from all-cause mortality through a period of 10 years. Kaplan-Meier curves are shown for the long-term survival in elderly patients with and without RA (A), according to age at the time of diagnosis of RA (B). Acknowledgements This research was supported by the Medical Research Promotion Program through Gangneung Asan Hospital funded by the Asan Foundation (Grant number 2020IB006). Disclosure of Interests None Declared.