Rheumatoid arthritis patients receive less frequent acute reperfusion and secondary prevention therapy after myocardial infarction compared with the general population

We performed a structured medical chart review of RA patients and matched controls who had been admitted with acute MI to one of three hospitals in Victoria, Australia, between 1995 and 2005. The administration and timing of acute reperfusion therapy and in-hospital treatment with secondary prevention medications were compared between the two groups. Acute reperfusion was defined as thrombolysis or percutaneous coronary intervention (PCI) within 12 hours of the first symptom of MI.The medical charts of 90 RA patients and 90 matched controls were reviewed. The RA patients were significantly less likely to receive acute reperfusion compared with the controls (16% versus 37%: odds ratio (OR), 0.27; 95% confidence interval (CI), 0.10 to 0.64)), and this difference persisted after adjusting for type of MI, clinical setting of MI, and prior MI (OR, 0.2; 95% CI, 0.05 to 0.6). The RA patients also received less-frequent in-hospital treatment with beta blockers (71% versus 83%; OR, 0.42; 95% CI, 0.18 to 0.96) and lipid-lowering agents (40% versus 70%; OR, 0.21; 95% CI, 0.09 to 0.46).RA patients who experience acute MI receive acute reperfusion and secondary prevention medications less frequently than do controls. This may contribute to higher case-fatality rates after MI in RA patients.Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that manifests primarily as inflammation in synovial joints. It is now widely recognized that RA patients also experience excess cardiovascular morbidity and mortality compared with the general population [1]. Not only do RA patients have an increased incidence of cardiovascular events, such as acute myocardial infarction (MI) [2-7], but they also have an increased case-fatality rate after acute MI compared with the general population [8-10]. For example, in our previous study of almost 30,000 individuals who had experienced a first acute MI, the adjusted odds ratio (OR) for 30-day mortality in RA patients versus controls wa