| 111. |
- Sederholm Lawesson, Sofia
(författare)
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Management and Outcome in ST-Elevation Myocardial Infarction from a Gender Perspective
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to evaluate baseline characteristics, management and outcome in real life ST-elevation myocardial infarction [STEMI] cohorts from a gender perspective. We aimed to evaluate the total STEMI population as well as certain subgroups, such as the youngest. Moreover we aimed to analyse gender differences in renal function, and the prognostic impact of reduced renal function in men and women with STEMI.In Paper I all STEMI patients registered in RIKS-HIA between 1st Jan 1995 and 31st Dec 2006 were included, in total 54 146 patients, 35% women. Women were 7 years older than men, with 30 min longer median symptomto-door time. They had higher prevalence of co-morbidities such as diabetes, hypertension and heart failure whereas men were more often smokers, had a previous myocardial infarction [MI] or were previously revascularised. During hospital care, fewer women than men, 63% vs. 72%, p<0.001, received acute reperfusion therapy, odds ratio [OR] 0.83 (95% confidence interval [CI] 0.79 – 0.88) after multivariable adjustment. Inhospital mortality was 13% vs. 7%, women vs. men, p<0.001. After multivariable adjustments women had 22% higher risk of in-hospital death, OR 1.22 (95% CI 1.11 – 1.33). Adding reperfusion therapy to the adjustment model did not change the odds of death, OR 1.21 (1.11 – 1.32). Stratifying the cohort into four age-groups revealed increased mortality with increasing age as well as higher mortality in women than in men in all groups. The multivariable adjusted risk in women relative to men was highest amongst the youngest, OR 1.45 (95% CI 0.98 – 2.14). The long term prognosis was assessed in women vs. men with Cox proportional regression analyses, follow-up time 1 to 13 years. Women had 8% lower risk of long term mortality after multivariable adjustments, and after age-stratifying, women had better long term survival in all age-groups, except the youngest.Previous studies based on mixed MI cohorts had found a gender-age interaction with higher risk of death women relative to men in the youngest group. In Paper II we included all STEMI patients <46 years old registered in RIKS-HIA between 1st Jan 1995 and 31st Dec 2006, 1748 men and 384 women. Cardiovascular risk factors were common, and women had more often clustering of risk factors compared to men. The most prevalent risk factor was smoking, 64% of the women compared to 58% of the men were current smokers. There was no gender difference in delay times or in rate of reperfusion. Almost 60% of both women and men underwent coronary angiography within one week. There was no gender difference in prevalence of non-obstructive disease, (p=0.64), but men had had multi-vessel/left main disease much more often than women (33.6% vs. 19.2%; p<0.001). In-hospital mortality was low, 3% in women vs. 1% in men, crude OR women vs. men 2.83 (95% CI 1.32 – 6.03). Female gender appeared as an independent predictor in the multivariable model of in-hospital mortality, OR 2.85 (95% CI 1.31– 6.19). When the cohort was followed up to 10 years (mean 5.4 years) the risk of mortality was not higher in women (hazard ratio [HR] 0.93, 95% CI 0.60 – 1.45; p=0.75), and men had significantly higher risk of a second new MI during the following 10 years, HR 1.82 (95% CI 1.25 – 2.65; p=0.002).In the beginning of the 21st century there was a shift in reperfusion strategy with a decline in use of fibrinolytic therapy and an increase in use of primary PCI. We hypothesised that the gender differences noticed during the fibrinolytic era with lower chance of receiving reperfusion therapy and higher risk of early mortality in women, would have diminished during the new primary PCI era, as this is a better reperfusion strategy, especially for women. In Paper III we included STEMI patients from two time periods with different dominating reperfusion strategies in order to compare management and outcome between genders in both periods. Patients in the early period (n=15 697, 35% women) were registered in RIKS-HIA between 1st Jan 1998 and 31st Dec 2000 and those in the late period (n=14 380, 35% women) between 1st Jan 2004 and 31st Dec 2006. Among patients treated with reperfusion therapy 9% in the early compared to 68% in the late period were treated with primary PCI. The use of reperfusion therapy increased between the two periods, in men from 70.9% to 75.3%, in women from 63.1% to 63.6%. After multivariable adjustment, women were 14% and 20% less likely than men to receive reperfusion therapy, early and late periods, respectively. Heart failure, cardiogenic chock and major bleedings were more common in women compared to men. Evidence-based secondary preventive therapies were prescribed more often in the late compared to the early period in both genders, but more seldom to women in both periods. After multivariable adjustments women still had less chance of receiving ACE-inhibitors/ARBs but higher chance of receiving statins in the early period. In the late period women had 14 – 25% less chance of receiving any of the evidence-based secondary preventive therapies.In Paper IV all consecutive patients who fulfilled the criteria for ST-elevation or bundle branch block on admission ECG and who were planned to undergo immediate coronary angiography with the intention to perform primary PCI at the Department of Cardiology in Linköping were included, 98 women and 176 men. Estimated glomerular filtration rate [eGFR] according to Modification of Diet in Renal Disease study [MDRD] was calculated for all patients and they were staged into CKD stages 1-5. Estimated GFR was lower in women than in men, mean eGFR 54 vs. 68 mL/min/1.73m2, p<0.001. Ten men but no woman were classified belonging to the best CKD stage 1(eGFR >90 mL/min/1.73m2). In total 67% of women compared to 27% of men were classified as having renal insufficiency [RI] (eGFR <60 mL/min/1.73m2) and female sex was a strong independent factor associated with RI, OR 5.06 (95% CI 2.66 – 9.59). Reduced eGFR per 10 mL/min decline was independently associated to higher risk of death and MACE (death, new MI or stroke) within one year in women whereas we found no such associations in men. There was a borderline significant interaction between gender and eGFR regarding one year mortality (p=0.08) but not regarding MACE (p=0.11).As we found a remarkable gender difference in RI prevalence in Paper IV, we analysed an updated SWEDEHEART database including the years since S-creatinine became a mandatory variable to register. In Paper V all STEMI patients registered between 1st of Jan 2003 and 31st of Dec 2009 were included, in total 37 991 patients (36% women). RI was present in 38% in women vs. 19% in men according to MDRD and in 50% of men vs. 22% of men according to Cockcroft Gault [CG] (p<0.001 for both comparisons). Female gender was independently associated with RI regardless of used formula. In both genders, RI patients were older, had higher co-morbidity, suffered from more complications and had lower chance of receiving reperfusion therapy and evidence-based therapy at discharge compared to non RI patients. Among both RI and non RI patients, men had significantly higher chance than women of getting these therapies. In-hospital mortality was four to five times higher in RI vs. non RI patients. RI compared to non RI patients had approximately doubled risk of inhospital mortality in women and 2.5 times higher risk in men after multivariable adjustment. Regardless of used formula, the risk of dying at hospital increased with approximately 30% and the risk of long term mortality with approximately 10% in both genders per 10 mL/min decline of eGFR. There was no significant interaction between gender and eGFR regarding short- or long term outcome according to any of the formulas. Women had twice as high in-hospital and also higher cumulative long term mortality than men. After multivariable adjustments including all confounders except kidney function women had 7% lower risk of long term mortality but still 11% higher risk of in-hospital mortality. If eGFR according to any of the formulas was also included, there was no longer a gender difference regarding in-hospital mortality and women had lower risk of long term mortality. This was also the case if only adjusting for eGFR according to CG.Conclusion: In the real life STEMI setting, women were older with higher co-morbidity, longer delay, more complications and twice as high in-hospital mortality. They had significantly less chance of receiving acute reperfusion therapy, also after adjusting for possible confounders. During the fibrinolytic era women had higher risk of severe bleedings. We hypothesised that the gap in management would have decreased during the new primary PCI era, with a less time-dependent regime with less risk of fatal complications. Our hypothesis failed, and future studies ought to further scrutinise this gender difference in management. The less chance of reperfusion therapy did anyhow not explain the higher in-hospital mortality in women, which was 10-20% higher after multivariable adjustments, consistent with previous findings. Moderate to severe chronic kidney disease was very common in women with STEMI, 50% according to the Cockcroft Gault formula. Estimated GFR has seldom been taken into account in studies evaluating gender differences in outcome. If adjustment for eGFR was done, alone or added to the all other co-variates, women had no longer higher risk of in-hospital mortality. Adjusted long term outcome was better in women than in men, which was also the case in the youngest cohort when studied separately.
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| 112. |
- Sederholm Lawesson, Sofia, et al.
(författare)
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Prevalence and prognostic impact of chronic kidney disease in STEMI from a gender perspective : data from the SWEDEHEART register, a large Swedish prospective cohort.
- 2015
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 5:6, s. e008188-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Gender differences in prevalence and prognostic impact of chronic kidney disease (CKD) in ST segment elevation myocardial infarction (STEMI) have been poorly evaluated. In STEMI, female gender has been independently associated with an increased risk of mortality. CKD has been found to be an important prognostic marker in myocardial infarction. The aim of this study was to evaluate gender differences in prevalence and prognostic impact of CKD on short-term and long-term mortality.DESIGN: Prospective observational cohort study.SETTING: The national quality register SWEDEHEART was used. In the beginning of the study period, 94% of the Swedish coronary care units contributed data to the register, which subsequently increased to 100%. The glomerular filtration rate was estimated (eGFR) according to Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG).PARTICIPANTS: All patients with STEMI registered in SWEDEHEART from the years 2003-2009 were included (37,991 patients, 66% men).MAIN RESULTS: Women had 1.6 (MDRD) to 2.2 (CG) times higher multivariable adjusted risk of CKD. Half of the women had CKD according to CG. CKD was associated with 2-2.5 times higher risk of in-hospital mortality and approximately 1.5 times higher risk of long-term mortality in both genders. Each 10 mL/min decline of eGFR was associated with an increased risk of in-hospital and long-term mortality (22-33% and 9-16%, respectively) and this did not vary significantly by gender. Both in-hospital and long-term mortality were doubled in women. After multivariable adjustment including eGFR, there was no longer any gender difference in early outcome and the long-term outcome was better in women.CONCLUSIONS: Among patients with STEMI, female gender was independently associated with CKD. Reduced eGFR was a strong independent risk factor for short-term and long-term mortality without a significant gender difference in prognostic impact and seems to be an important reason why women have higher mortality than men with STEMI.
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| 113. |
- Sederholm Lawesson, Sofia, et al.
(författare)
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Prevalence and prognostic impact of renal insufficiency in STEMI from a gender perspective : data from a large prospective cohort
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Data indicate that female gender may be associated with increased risk of RI in MI but also that presence of RI has higher prognostic impact in women. In case of ST-elevation MI [STEMI], women have higher adjusted mortality compared to men but RI has seldom been taken into account. Methods and Results: All STEMI patients registered in the Swedish national quality register SWEDEHEART between 2003 and 2009 were included (37991 patients, 66% men). Based on s-creatinine on admission, glomerular filtration rate [GFR] was estimated according to MDRD and Cockcroft-Gault [CG]. RI was defined as eGFR below 60 mL/min. Women had 1.6-2.2 times higher multivariable adjusted risk of RI and half of all women had RI according to CG. RI was associated with 2-2.5 times higher risk of in-hospital and approximately 1.5 times higher risk of long-term mortality in both genders. Each 10 mL/min decline of eGFR was associated with 22-33% and 9-16% increased risk of in-hospital and. long-term mortality, respectively. There was no significant interaction between gender and eGFR regarding outcome. Both in-hospital and long-term mortality was twice as high in women but after adjusting for eGFR according to CG, there was no longer any gender difference in early outcome and long term outcome was better in women. Conclusions: Among STEMI patients 1) Female sex was independently associated with RI 2) Reduced eGFR regardless of used formula was a strong independent risk factor for mortality without a significant gender difference in prognostic impact. 3) Reduced eGFR (according to CG) appeared to be a main explanatory variable to the higher mortality in women.
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| 114. |
- Sederholm Lawesson, Sofia, et al.
(författare)
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Time trends in STEMI—improved treatment and outcome but still a gender gap : a prospective observational cohort study from the SWEDEHEART register
- 2012
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2:2
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Tidskriftsartikel (refereegranskat)abstract
- Objective In ST elevation myocardial infarction women received less evidence-based medicine and had worse outcome during the fibrinolytic era. With the shift to primary percutaneous coronary intervention (pPCI) as preferred reperfusion strategy, the authors aimed to investigate whether these gender differences has diminished.Design, setting and participants Cohort study including consecutive ST elevation myocardial infarction patients registered 1998–2000 (n=15 697) and 2004–2006 (n=14 380) in the Register of Information and Knowledge about Swedish Heart Intensive care Admissions.Outcome measures 1. Use of evidence-based medicine such as reperfusion therapy (pPCI or fibrinolysis) and evidence-based drugs at discharge. 2. Inhospital and 1-year mortality.Results Of those who got reperfusion therapy, pPCI was the choice in 9% in the early period compared with 68% in the late period. In the early period, reperfusion therapy was given to 63% of women versus 71% of men, p<0.001. Corresponding figures in the late period were 64% vs 75%, p<0.001. After multivariable adjustments, the ORs (women vs men) were 0.86 (95% CI 0.78 to 0.94) in the early and 0.80 (95% CI 0.73 to 0.89) in the late period. As regards evidence-based secondary preventive drugs at discharge in hospital survivors (platelet inhibitors, statins, ACE inhibitors/angiotensin receptor blockers and β-blockers), there were small gender differences in the early period. In the late period, women had 14%–25% less chance of receiving these drugs, OR 0.75 (95% CI 0.68 to 0.81) through 0.86 (95% CI 0.73 to 1.00). In both periods, multivariable-adjusted inhospital mortality was higher in women, OR 1.18 (95% CI 1.02 to 1.36) and 1.21 (1.00 to 1.46). One-year mortality was gender equal, HR 0.95 (95% CI 0.87 to 1.05) and 0.96 (0.86 to 1.08), after adding evidence-based medicine to the multivariable adjustments.Conclusion In spite of an intense gender debate, focus on guideline adherence and the change in reperfusion strategy, the last decade gender differences in use of reperfusion therapy and evidence-based therapy at discharge did not decline during the study period, rather the opposite. Moreover, higher mortality in women persisted.
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| 115. |
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| 116. |
- Silverio, Angelo, et al.
(författare)
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Percutaneous Treatment and Outcomes of Small Coronary Vessels A SCAAR Report
- 2020
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Ingår i: JACC. - : ELSEVIER SCIENCE INC. - 1936-8798 .- 1876-7605. ; 13:7, s. 793-804
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES The aim of this study was to investigate the outcomes of patients with de novo lesions in small coronary vessels undergoing percutaneous coronary intervention (PCI) with drug-coated balloons (DCBs) or newer-generation drug-eluting stents (n-DES). BACKGROUND Notwithstanding the available evidence from a few randomized clinical trials and meta-analyses, the best device for PCI in patients with small-vessel coronary artery disease is not yet established. METHODS The study included all consecutive patients with de novo lesions in small coronary vessels undergoing PCI in Sweden from April 2009 to July 2017. A small coronary vessel was defined by a device diameter <= 2.5 mm. The primary outcomes were restenosis and definite target lesion thrombosis at 3-year follow-up. The secondary outcomes were the occurrence of all-cause death and myocardial infarction. RESULTS The study population included 14,788 patients: 1,154 treated with DCBs and 13,634 with n-DES. Overall, 35,541 PCIs were performed using 2,503 DCBs and 33,038 n-DES. The propensity score-adjusted regression analysis showed a significantly higher risk for restenosis in the DCB group compared with the n-DES group (adjusted hazard ratio [HR]: 2.027; 95% confidence interval [CI]: 1.537 to 2.674). Conversely, no difference in the risk for target lesion thrombosis (adjusted HR: 0.741; 95% CI: 0.412 to 1.331) was detected. The risk for all-cause death (adjusted HR: 1.178; 95% CI: 0.992 to 1.399) and myocardial infarction (adjusted HR: 1.251; 95% CI: 0.960 to 1.629) was comparable between groups. CONCLUSIONS Because of the significantly higher risk for restenosis up to 3 years, this research suggests that DCBs are not an equally effective alternative to n-DES for percutaneous treatment of small coronary vessels. (C) 2020 by the American College of Cardiology Foundation.
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| 117. |
- Simonsson, Moa, et al.
(författare)
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Association of Ischemic and Bleeding Events With Mortality Among Patients in Sweden With Recent Acute Myocardial Infarction Receiving Antithrombotic Therapy
- 2022
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Ingår i: JAMA Network Open. - : American Medical Association. - 2574-3805. ; 5:8
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Antithrombotic treatment after myocardial infarction (MI) should be individualized based on the patients risk of ischemic and bleeding events. Uncertainty remains regarding the relative prognostic importance of the 2 types of events, and further study would be useful. OBJECTIVES To compare the association of ischemic vs bleeding events with mortality in patients with a recent MI and assess whether the relative mortality risk for the 2 types of events has changed over the past 2 decades. DESIGN, SETTING, AND PARTICIPANTS A cohort study based on nationwide registers in Sweden, 2012-2017, was conducted. Data were analyzed between July 2021 and May 2022. Patients with MI who were discharged alive with antithrombotic therapy (antiplatelet therapy or oral anticoagulation) were included in the analysis. MAIN OUTCOMES AND MEASURES The incidence of a first ischemic event (hospitalization for MI or ischemic stroke) or bleeding event (hospitalization with bleeding) up to 1 year after discharge and the mortality risk up to 1 year after each type of event were assessed. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (a HRs) for 1-year mortality after an ischemic and bleeding event vs no event, and after an ischemic vs bleeding event. Adjusted HRs for mortality after ischemic vs bleeding events were compared among patients discharged in 1997-2000, 2001-2011, and 2012-2017. RESULTS Of 86 736 patients discharged after MI in 2012-2017 (median age, 71 [IQR, 62-80] years; 57 287 [66.0%] men), 4039 individuals experienced a first ischemic event (5.7 per 100 person-years) and 3399 experienced a first bleeding event (4.8 per 100 person-years). The mortality rate was 46.2 per 100 person-years after an ischemic event and 27.1per 100 person-years after a bleeding event. The aHR for 1-year mortality vs no event was 4.16 (95% CI, 3.91-4.43) after an ischemic event and 3.43 (95% CI. 3.17-3.71) after a bleeding event. When the 2 types of events were compared, the aHR was 1.27 (95% CI, 1.15-1.40) for an ischemic vs bleeding event. There was no statistically significant difference in the aHR of an ischemic vs bleeding event in 1997-2000, 2001-2011, and 2012-2017. CONCLUSIONS AND RELEVANCE In this nationwide cohort study of patients with a recent MI, postdischarge ischemic events were more common and associated with higher mortality risk compared with bleeding events.
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| 118. |
- Simonsson, Moa, et al.
(författare)
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Development and Validation of a Novel Risk Score for In-Hospital Major Bleeding in Acute Myocardial Infarction : The SWEDEHEART Score
- 2019
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Ingår i: Journal of the American Heart Association. - : WILEY. - 2047-9980. ; 8:5
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Tidskriftsartikel (refereegranskat)abstract
- Background – Bleeding risk stratification in acute coronary syndrome is of highest clinical interest but current risk scores have limitations. We sought to develop and validate a new in-hospital bleeding risk score for patients with acute myocardial infarction.Methods and Results – From the nationwide SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register, 97,597 patients with acute myocardial infarction enrolled from 2009 until 2014 were selected. A full model with 23 predictor variables and 8 interaction terms was fitted using logistic regression. The full model was approximated by a model with 5 predictors and 1 interaction term. Calibration, discrimination, and clinical utility was evaluated and compared with the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) and CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) scores. Internal and temporal validity was assessed. In-hospital major bleeding, defined as fatal, intracranial, or requiring surgery or blood transfusion, occurred in 1356 patients (1.4%). The 5 predictors in the approximate model that constituted the SWEDEHEART score were hemoglobin, age, sex, creatinine, and Creactive protein. The ACTION and CRUSADE scores were poorly calibrated in the derivation cohort and therefore were recalibrated. The SWEDEHEART score showed higher discriminative ability than both recalibrated scores, overall (C-index 0.80 versus 0.73/0.72) and in all predefined subgroups. Decision curve analysis demonstrated consistently positive and higher net benefit for the SWEDEHEART score compared with both recalibrated scores across all clinically relevant decision thresholds. The original ACTION and CRUSADE scores showed negative net benefit.Conclusions – The 5-item SWEDEHEART score discriminates in-hospital major bleeding in patients with acute myocardial infarction and has superior model performance compared with the recalibrated ACTION and CRUSADE scores.
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| 119. |
- Simonsson, Moa, et al.
(författare)
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Temporal trends in bleeding events in acute myocardial infarction : insights from the SWEDEHEART registry
- 2020
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 41:7, s. 833-843
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To describe the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population.METHODS AND RESULTS: Patients with acute MI (n = 371 431) enrolled in the SWEDEHEART registry from 1995 until May 2018 were selected and evaluated for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5 % in the middle of the study period and to 4.8% at the end of the study period. The increase in both in-hospital and out-of-hospital bleeding was parallel to increasing use of invasive strategy and adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT), and potent DAPT, while the decrease in in-hospital bleeding from 2007 to 2010 was parallel to implementation of bleeding avoidance strategies. In-hospital re-infarction decreased from 2.8% to 0.6% and out-of-hospital MI decreased from 12.6% to 7.1%. The composite out-of-hospital MI, cardiovascular death, and stroke decreased in a similar fashion from 18.4% to 9.1%.CONCLUSION: During the last 20 years, the introduction of invasive and more intense antithrombotic treatment has been associated with an increase in bleeding events but concomitant there has been a substantial greater reduction of ischaemic events including improved survival.
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| 120. |
- Skibniewski, Mikolaj, et al.
(författare)
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Long-term antithrombotic therapy after coronary artery bypass grafting in patients with preoperative atrial fibrillation. A nationwide observational study from the SWEDEHEART registry
- 2023
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 257, s. 69-77
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Tidskriftsartikel (refereegranskat)abstract
- Aims To provide data guiding long-term antithrombotic therapy after coronar y arter y by-pass grafting (CABG) in patients with preoperative atrial fibrillation (AF). Methods and results From the SWEDEHEART registry, we included all patients, between January 2006 and September 2016, with preoperative AF and CHA2DS2-VASC score >2, undergoing CABG. Based on dispensed prescriptions 12 to 18 months after CABG, patients were divided in 3 groups: use of platelet inhibitors (PI) only, oral anticoagulant (OAC) only or a combination of OAC + PI. Outcomes were: Major adverse cardiac and cerebrovascular events (MACCE, [all-cause death, myocardial infarction, or stroke]), net adverse clinical events (NACE, [MACCE or bleeding]) and the individual components of NACE. Inverse probability of treatment weighting was used to adjust for the non-randomized study design. Among 2,564 patients, 1,040 (41%) were treated with PI alone, 1,064 (41%) with OAC alone, and 460 (18%) with PI + OAC. Treatment with PI alone was associated with higher risk for MACCE (adjusted HR 1.43, 95% CI 1.09-1.88), driven by higher risk for stroke and MI, compared with OAC alone. Treatment with PI + OAC, was associated with higher risk for NACE (adjusted HR 1.40, 95% CI 1.06-1.85), driven by higher risk for bleeds, compared with OAC alone. Conclusion In this real-world observational study, a high proportion of patients with AF, undergoing CABG, did not receive a long-term OAC therapy. Treatment with OAC alone was associated with a net clinical benefit, compared with PI alone or PI + OAC. (Am Heart J 2023;257:69-77.)
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