Mortality risk elevated in UC patients with CAD

Ulcerative colitis (UC) patients with active coronary artery disease (CAD) appear to be at greater risk of mortality than those with Crohn’s disease (CD), suggest the results of a study presented at AIBD 2025.

Furthermore, “[p]atients with increased age, additional comorbidities, and presentation with ST-segment elevation myocardial infarction (STEMI) are at particularly higher risk,” said lead study author Dr Eleazar E Montalvan-Sanchez, Yale University, New Haven, Connecticut, US.

In this retrospective cohort study, Montalvan-Sanchez and colleagues used the National Inpatient Sample (2016‒2021) to assess patients with IBD admitted with a principal diagnosis of CAD and explore the mortality patterns as well as contributing factors in this population. They evaluated same-admission major adverse cardiovascular events, with a focus on mortality differences between UC and CD.

Moreover, the authors carried out analyses such as t-tests and logistic regression, with risk reported as odds ratios (ORs). The models used were adjusted for age, sex, hospital characteristics, and insurance status and were stratified by admission day, coronary revascularization, and myocardial infarction. STATA 18 was used to perform the analyses.

A total of 233,450 patients with IBD were admitted for CAD. Of these, 135,785 had CD (mean age 69.15 years, and 97,665 had UC (mean age 72.67 years). More than half of the patients were male (55.09 percent), and the majority were White (86.09 percent), followed by Black (6.05 percent), Hispanics (4.27 percent), and other (3.59 percent).

Among the IBD patients, 7,635 died during admission, resulting in a 3.27-percent mortality rate. The risk of mortality was greater among patients with UC than those with CD (mortality rate: 3.79 percent vs 2.89 percent, respectively). [AIBD 2025, abstract 49]

IBD patients who presented with STEMI had a significantly increased mortality, with the highest risk seen among those with CD. Furthermore, increased age and a high Charlson Comorbidity Index were significantly associated with elevated mortality. On the other hand, presentation with non-STEMI or during weekdays correlated with lower mortality.

Interventions

Of note, the lack of intervention resulted in substantially greater mortality across all patient groups (UC: OR, 3.29; CD: OR, 2.30; IBD: OR, 2.69; p<0.01 for all).

IBD patients who underwent percutaneous coronary intervention had a better chance at survival (mortality rate 68 percent; p<0.01). However, same admission coronary artery bypass grafting showed no significant association with a change in mortality. Additionally, undergoing coronary artery revascularization contributed to a 34-percent decrease in mortality among IBD patients (p<0.01).

“This study highlights the importance of timely recognition and intervention in IBD patients admitted for active CAD, especially among those with UC, where systemic inflammation, comorbidity burden, and severe acute coronary syndrome presentations may contribute to poorer outcomes,” Montalvan-Sanchez said.

“CD and UC are chronic autoimmune conditions increasingly linked to elevated risks of cardiovascular complications such as CAD,” according to the authors.