Patients with rheumatoid arthritis (RA) are at increased risk of coronary artery disease (CAD) and seem to develop more severe acute coronary syndromes (ACS) than the general population. Only a few studies have investigated the CAD distribution in the context of acute or stable CAD in RA. A population‐based study was performes using the linkages of nationwide clinical‐, health‐ and demographics registers. Cardiovascular characteristics, presence, and distribution of clinically significant stenoses were compared (through odds ratios (OR)), stratified by indication (stable CAD/ST‐elevation myocardial infarction [STEMI]/non‐ST ACS [NSTACS]), using logistic regression.

We identified 2,985 patients with RA and 10,290 patients without RA who underwent a first coronary angiography. A higher proportion of RA patients (75% vs. 69%) had STEMI and NSTACS as indications for angiography. There was no difference observed in the distribution and presence of clinically significant coronary stenoses in RA compared with the patients without RA, regardless of CAD‐type (OR for having major stenosis in stable CAD = 0.9, STEMI OR=0.8, NSTACS OR=1.1), stratification by RA duration, sex, or burden of concomitant CV risk factors.

In conclusion, although RA may accelerate the development of clinical CAD events, the underlying angiographic characteristics are similar to those in patients without RA.