Comparative Outcomes After Index Myocardial Infarction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

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 with non-IBD controls. METHODS: A systematic review and meta-analysis was conducted following PRISMA guidelines. Five 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% CIs. Heterogeneity was assessed using the I2 statistic. RESULTS: Nine retrospective cohort studies encompassing 9.45 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) following index myocardial infarction compared with non-IBD patients. Pooled ORs showed increased odds of 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) and no significantly increased odds of stroke. CONCLUSIONS: Patients with IBD have statistically significantly higher risks of MACE, all-cause mortality, recurrent MI, blood transfusions, and major bleeding compared with the non-IBD population. These findings emphasize the potential role for tailored cardiovascular risk stratification, bleeding risk mitigation, and longitudinal management strategies in patients with IBD.