Outcomes associated with dual antiplatelet therapy after myocardial infarction in patients with aortic stenosis
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Outcomes associated with dual antiplatelet therapy after myocardial infarction in patients with aortic stenosis. / Martinsson, Andreas; Li, Xinjun; Torp-Pedersen, Christian; Zöller, Bengt; Andell, Pontus; Andreasen, Charlotte; Gislason, Gunnar; Køber, Lars; Sundquist, Kristina; Smith, J Gustav; Andersson, Charlotte.
I: International Journal of Cardiology, Bind 281, 15.04.2019, s. 140-145.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Outcomes associated with dual antiplatelet therapy after myocardial infarction in patients with aortic stenosis
AU - Martinsson, Andreas
AU - Li, Xinjun
AU - Torp-Pedersen, Christian
AU - Zöller, Bengt
AU - Andell, Pontus
AU - Andreasen, Charlotte
AU - Gislason, Gunnar
AU - Køber, Lars
AU - Sundquist, Kristina
AU - Smith, J Gustav
AU - Andersson, Charlotte
N1 - Copyright © 2019 Elsevier B.V. All rights reserved.
PY - 2019/4/15
Y1 - 2019/4/15
N2 - BACKGROUND: Acquired loss of the largest von Willebrand factor multimers is a common hemostatic disturbance in patients with aortic valve stenosis (AS), resulting in impaired platelet adhesion and increased bleeding risk. AS is also associated with atherosclerosis and myocardial infarction (MI). Our aim was to study the clinical outcomes associated with AS in MI patients treated with dual antiplatelet therapy (DAPT) in a nationwide hospital-based register study.METHODS: Based on nationwide hospital discharge registers from Sweden (2005-2010) and Denmark (2005-2015), we calculated 1-year incidence rates and hazard ratios of bleeding, recurrent MI, and all-cause mortality in MI patients with and without AS treated with DAPT. Results from both countries were also combined in a meta-analysis.RESULTS: We included 50,460 MI patients from Sweden and 50,307 MI patients from Denmark, of which 3% had AS. The bleeding rates (per 100 person-years) in Sweden and Denmark were 3.2 and 3.3 among patients without AS vs. 9.2 and 8.3 among patients with AS. All-cause mortality rates were 7.1 vs. 28.7 in Sweden and 5.8 vs. 30.7 in Denmark among patients without and with AS, respectively. Patients with AS had an increased risk of bleeding, recurrent MI and all-cause mortality. Combined results from both countries were similar for bleeding (hazard ratio 1.59 [0.98-2.59]), recurrent MI (1.78 [1.25-2.54]), and all-cause mortality (1.76 [1.26-2.47]).CONCLUSION: AS was associated with an increased risk of bleeding, recurrent MI and mortality after MI when treated with DAPT. Individualized selection of antiplatelet therapy may be warranted in this high-risk population.
AB - BACKGROUND: Acquired loss of the largest von Willebrand factor multimers is a common hemostatic disturbance in patients with aortic valve stenosis (AS), resulting in impaired platelet adhesion and increased bleeding risk. AS is also associated with atherosclerosis and myocardial infarction (MI). Our aim was to study the clinical outcomes associated with AS in MI patients treated with dual antiplatelet therapy (DAPT) in a nationwide hospital-based register study.METHODS: Based on nationwide hospital discharge registers from Sweden (2005-2010) and Denmark (2005-2015), we calculated 1-year incidence rates and hazard ratios of bleeding, recurrent MI, and all-cause mortality in MI patients with and without AS treated with DAPT. Results from both countries were also combined in a meta-analysis.RESULTS: We included 50,460 MI patients from Sweden and 50,307 MI patients from Denmark, of which 3% had AS. The bleeding rates (per 100 person-years) in Sweden and Denmark were 3.2 and 3.3 among patients without AS vs. 9.2 and 8.3 among patients with AS. All-cause mortality rates were 7.1 vs. 28.7 in Sweden and 5.8 vs. 30.7 in Denmark among patients without and with AS, respectively. Patients with AS had an increased risk of bleeding, recurrent MI and all-cause mortality. Combined results from both countries were similar for bleeding (hazard ratio 1.59 [0.98-2.59]), recurrent MI (1.78 [1.25-2.54]), and all-cause mortality (1.76 [1.26-2.47]).CONCLUSION: AS was associated with an increased risk of bleeding, recurrent MI and mortality after MI when treated with DAPT. Individualized selection of antiplatelet therapy may be warranted in this high-risk population.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve Stenosis/drug therapy
KW - Denmark/epidemiology
KW - Dual Anti-Platelet Therapy/adverse effects
KW - Female
KW - Follow-Up Studies
KW - Hemorrhage/chemically induced
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/drug therapy
KW - Platelet Aggregation Inhibitors/administration & dosage
KW - Registries
KW - Sweden/epidemiology
KW - Treatment Outcome
U2 - 10.1016/j.ijcard.2019.01.063
DO - 10.1016/j.ijcard.2019.01.063
M3 - Journal article
C2 - 30722957
VL - 281
SP - 140
EP - 145
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -
ID: 235000604