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Trade-off of myocar...
Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome : lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial
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- Valgimigli, Marco (författare)
- Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.;Erasmus MC, Thoraxctr, Rotterdam, Netherlands.
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- Costa, Francesco (författare)
- Erasmus MC, Thoraxctr, Rotterdam, Netherlands.;Univ Messina, Dept Clin & Expt Med, Policlin G Martino, Messina, Italy.
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- Lokhnygina, Yuliya (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Clare, Robert M. (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Wallentin, Lars (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Moliterno, David J. (författare)
- Univ Kentucky, Div Cardiovasc Med, Gill Heart Inst, Lexington, KY USA.
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- Armstrong, Paul W. (författare)
- Univ Alberta, Div Cardiol, Edmonton, AB, Canada.
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- White, Harvey D. (författare)
- Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand.
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- Held, Claes (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Aylward, Philip E. (författare)
- Flinders Univ S Australia, South Australian Hlth & Med Res Inst, Adelaide, SA, Australia.;Med Ctr, Adelaide, SA, Australia.
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- Van de Werf, Frans (författare)
- Univ Leuven, Dept Cardiol, Leuven, Belgium.
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- Harrington, Robert A. (författare)
- Stanford Univ, Dept Med, Stanford, CA 94305 USA.
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- Mahaffey, Kenneth W. (författare)
- Stanford Univ, Dept Med, Stanford, CA 94305 USA.
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- Tricoci, Pierluigi (författare)
- Duke Clin Res Inst, Durham, NC USA.
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Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland;Erasmus MC, Thoraxctr, Rotterdam, Netherlands. Erasmus MC, Thoraxctr, Rotterdam, Netherlands.;Univ Messina, Dept Clin & Expt Med, Policlin G Martino, Messina, Italy. (creator_code:org_t)
- 2016-11-13
- 2017
- Engelska.
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 38:11, s. 804-810
- Relaterad länk:
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https://academic.oup...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Aims: Dual antiplatelet therapy reduces non-fatal ischaemic events after acute coronary syndrome (ACS) but increases bleeding to a similar extent. We sought to determine the prognostic impact of myocardial infarction (MI) vs. bleeding during an extended follow-up period to gain insight into the trade-off between efficacy and safety among patients after ACS.Methods and results: In 12 944 patients with non-ST-segment elevation ACS from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial, we investigated the relative impact of MI and bleeding occurring> 30 days post-ACS and subsequent all-cause mortality. Bleeding was graded according to Bleeding Academic Research Consortium (BARC) criteria. MI was associated with a five-fold increase in mortality. BARC type 2 and 3, but not type 1, bleeding had a significant impact on mortality. MI was associated with a greater risk of mortality compared with BARC 2 [relative risk (RR) 3.5; 95% confidence interval (CI) 2.08-4.77; P< 0.001] and BARC 3a bleeding (RR 2.23; 95% CI 1.36-3.64; P = 0.001), and a risk similar to BARC 3b bleeding (RR 1.37; 95% CI 0.81-2.30; P = 0.242). Risk of death after MI was significantly lower than after BARC 3c bleeding (RR 0.22; 95% CI 0.13-0.36; P< 0.001). MI and bleeding had similar time-associations with mortality, which remained significant for several months, still being higher early after the event.Conclusion: In patients treated with antiplatelet therapy after ACS, both MI and bleeding significantly impacted mortality with similar time-dependency. Although BARC 2 and 3a bleeding were less prognostic for death than MI, the risk of mortality was equivalent between BARC 3b bleeding and MI, and was higher following BARC 3c bleeding.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- Bleeding
- Myocardial infarction
- DAPT
- Acute coronary syndrome
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Valgimigli, Marc ...
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Costa, Francesco
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Lokhnygina, Yuli ...
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Clare, Robert M.
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Wallentin, Lars
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Moliterno, David ...
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visa fler...
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Armstrong, Paul ...
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White, Harvey D.
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Held, Claes
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Aylward, Philip ...
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Van de Werf, Fra ...
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Harrington, Robe ...
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Mahaffey, Kennet ...
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Tricoci, Pierlui ...
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European Heart J ...
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