COMPARATIVE OUTCOMES AFTER INDEX MYOCARDIAL INFARCTION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND Inflammatory bowel disease (IBD) is a chronic systemic inflammatory disorder associated with elevated cardiovascular risk. While prior studies have linked IBD to increased risk of myocardial infarction (MI), post-MI outcomes in this population remain poorly characterized. We aimed to evaluate post-MI outcomes in patients with IBD compared to non-IBD controls. METHODS A systematic review and meta-analysis was conducted following MOOSE guidelines. 5 databases were searched from inception to July 2025. We included observational studies comparing post-MI outcomes in adults with and without IBD. Random-effects meta-analyses were performed using hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated using funnel plots and Egger’s regression test. RESULTS Eleven retrospective cohort studies encompassing 18.8 million patients were included. IBD was associated with significantly increased risk of MACE (HR 1.31, 95% CI: 1.07-1.59), all-cause mortality (HR 1.25, 95% CI: 1.12-1.39), and recurrent MI (HR 1.22, 95% CI: 1.08-1.39). Pooled ORs showed increased odds of recurrent MI (OR 2.11, 95% CI: 1.06-4.18), major bleeding (OR 1.38, 95% CI: 1.13-1.70), and transfusion (OR 1.41, 95% CI: 1.35-1.47), but lower odds of heart failure (OR 0.81, 95% CI: 0.74-0.89). Odds ratios for MACE, stroke, and mortality were not significantly elevated. CONCLUSIONS Patients with IBD experience worse outcomes following MI, including higher risks of MACE, recurrent MI, and mortality. These findings emphasize the need for tailored cardiovascular risk stratification, bleeding risk mitigation, and longitudinal management strategies in patients with IBD.