Background Cardiovascular diseases (myocardial infarction, coronary insufficiency, sudden death) are the leading cause of mortality in patients with RA. Noninvasive diagnostic methods (ECG, 24-ECG, stress tests ECG) are useful to diagnose myocardial ischemia, but don’t determine the probability of latent coronary artery atherosclerotic lesion.
Objectives To diagnose myocardial ischemia and coronary artery lesions by clinical and instrumental diagnostic methods in RA pts.
Methods 43 RA pts (24 female, 17 male) with median (Me) age 54 [interquartile range (IR) 32;64] years who meet the 1987 ARA revised criteria for the classification of RA were studied. Disease duration was 96 months. Disease activity was measured by DAS 28. The high RA activity was observed in 37% pts. RF IgM positivity was in 72% pts, ACCP positivity- in 51% pts. All RA pts received NSAIDs therapy, 28 (63%) pts – glucocorticoids (prednisolone) (mean dose of 5,7 mg, therapy duration- 28 months), 30 (69,7%) pts- methotrexate, 7 (16,2%) pts - leflunomide, 6 (13,9%) - sulfasalasine, 6 pts – TNF-α inhibitors, 3 pts – rituximab, 1 pts - tocilizumab. Traditional cardiovascular risk factors determinations (ESK 2007), ECG, 24 - ECG, stress tests ECG, coronarography were performed in all RA pts.
Results Angina pectoris was diagnosed in 4/43 (9,3%) RA pts, myocardial infarction – in 6/43 (13,9%) in the age <55 years. According 24-ECG monitoring 29/43 (67,4%) RA pts had no changes, 5/43 (11,6%) had painless ST-T depression (2 mm), 2/43 (4,7%) - painful ST-T depression. Stress tests ECG was positive in 12/43 (27,9%) RA pts, negative - in 4/43 (9,3%) pts, doubtful – 27/43 (62,7%) pts, because of functional insufficiency. Coronary artery lesions were evaluated in 19/43 (44,1%) pts by coronarography: 7/19 (36,8%) had multivessel lesion, 2/19 (10,5%) - bivessel lesion, 10/19 (52,6%) -monovessel lesion. Coronary revascularization was performed in 10 (52,6%) RA pts (6 - transluminal balloon angioplasty with coronary artery stenting, 4 - coronary arteries bypass grafting). All RA pts were divided into 2 groups in depending on coronary arteries condition: 1 group (n=19) - pts with coronary artery lesion, 2 group (n=24) – pts without coronary artery lesion. Disease duration [(Me interquartile range (IR)120 (78-192) months vs 33 (6,7-135) months)] and glucocorticoids therapy duration (35±30,4 mg vs 12 ±1,7 mg, p<0,05) were longer in 1 group in compare with 2 group. More patients from 1 group received biological treatment (32% vs 13%), but difference was not significant (p=0,08).
Traditional cardiovascular risk factors prevalence, DAS 28, RF- and ACCP - positivity were not significantly differ between two groups of RA pts.
Conclusions RA pts have high frequency of myocardial ischemia and coronary atherosclerosis. Noninvasive diagnostic methods don’t usually evaluate the coronary artery lesion. Coronarography is the most precise method to diagnose latent coronary atherosclerosis in RA pts.
Disclosure of Interest None Declared