naa a22 4500 510760473 CHVBK 20180411083137.0 cr unu---uuuuu 180411e20130701xx s 000 0 eng 10.1007/s11420-012-9309-5 doi (NATIONALLICENCE)springer-10.1007/s11420-012-9309-5 First Time Myocardial Infarction in a Rheumatic Patient After Elective Arthroplasty [Elektronische Daten] [James Calloway, Susan Goodman, Wesley Hollomon, Linda Russell, Daniel Krauser] The management of perioperative cardiovascular risk in patients with rheumatoid arthritis (RA) is challenging due to the independent contribution to risk by high grade inflammatory mechanisms and the underestimation of risk by traditional cardiac risk factors alone. RA is associated with accelerated rates of subclinical atherosclerosis and markedly higher rates of both myocardial infarction and sudden cardiac death over non-RA controls. There is an absence of prospectively validated perioperative coronary heart disease (CHD) risk assessment tools for this unique patient population and available guidelines may fail to identify those patients most at risk. We examine a singular case of first time myocardial infarction after uncomplicated elective surgery in an adult RA patient with an unrevealing preoperative cardiac assessment. We also review the current literature for shared pathogenic mechanisms between systemic inflammation and atherosclerosis, discuss clinical and biologic markers such as C-reactive protein (CRP) in RA patients associated with heightened cardiac risk and discuss recommendations based on available evidence for cardiovascular risk management in this at risk cohort. Hospital for Special Surgery, 2013 rheumatoid arthritis (RA) nationallicence coronary heart disease (CHD) nationallicence C-reactive protein (CRP) nationallicence Calloway James Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Goodman Susan Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Hollomon Wesley Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Russell Linda Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Krauser Daniel Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut HSS Journal ® Springer US; http://www.springer-ny.com 9/2(2013-07-01), 203-207 1556-3316 9:2<203 2013 9 11420 https://doi.org/10.1007/s11420-012-9309-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11420-012-9309-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Calloway James Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Goodman Susan Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Hollomon Wesley Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Russell Linda Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Krauser Daniel Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 773 0- HSS Journal ® Springer US; http://www.springer-ny.com 9/2(2013-07-01), 203-207 1556-3316 9:2<203 2013 9 11420 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer