In a large cohort study of 2757 patients with RA treated with infliximab, etanercept, or adalimumab, a significant increase in heart failure was reported in patients with high disease activity and concomitant glucocorticoid or COX inhibitor therapy, while anti-TNF therapy did not significantly contribute to the risk; only sporadic cases of acute coronary syndromes, arrhythmias, and AV block for infliximab were reported [115]. This evidence concerns the gene TNF and acute coronary syndrome.