A Lower Frequency of ST-Elevation Myocardial Infarction in Patients with Gout

 

Panagiota Drivelegka, Lennart Jacobsson, Tatiana Zverkova-Sandström, Mats Dehlin

 

Affiliation(s):

Department of rheumatology and inflammation research, institution of medicin, sahlgrenska academy at university of gothenburg

 

 

Background: Patients with gout are at increased risk of acute myocardial infarction (AMI)1. However, its clinical characteristics have not been previously studied. 

Objectives: The aim of this study was to investigate the clinical characteristics of first-ever AMI in patients with gout compared to the general population. 

Methodology: Using data from regional and national population-based registers, we identified all patients with a diagnosis of gout at both primary and specialized care in Western Sweden and a first-ever AMI in the period 2006-2016. Each subject was matched on sex and admission year with up to 5 comparators from the general population. Clinical presentation at admission, and clinical course in gout cases and controls were compared by using logistic regression analysis.

Results: We identified 1,000 patients with gout (men, 72.7%; mean age, 70.0 years) and 4,740 matched general population comparators (men, 73.5%; mean age, 71.5 years) with a first-ever AMI. Patients with gout had significantly more comorbidities compared to the general population (Table 1). At admission, patients with gout had significantly lower odds of ST-elevation myocardial infarction (STEMI) (OR, 0.84; 95%CI, 0.72-0.99) and higher odds of atrial fibrillation (AF) (OR, 1.93; 95%CI, 1.62–2.31) and severely depressed left ventricular function (OR, 1.35; 95%CI, 1.00–1.82) (Table 2). Gout patients were significantly more likely to receive treatment with continuous positive airway pressure, and less likely to undergo coronary angiography, percutaneous coronary intervention (PCI), or any revascularization during hospitalization (Table 2). The duration of hospitalization for first-ever AMI was longer in gout patients than in controls (7.5 vs 6.4 days; p-value, <0.001). 

Conclusions: Patients with gout were significantly less likely to present with STEMI at admission for first-ever AMI compared to the general population, but they were more likely to present with AF and severely depressed left ventricular function. Furthermore, they were less likely to undergo coronary angiography and PCI during hospitalization, as compared to the general population.

References
1. Drivelegka P, Arthritis Care Res (Hoboken). 2023 Jun;75(6):1292-1299.