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Differential occurr...
Differential occurrence, profile, and impact of first recurrent cardiovascular events after an acute coronary syndrome
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- Hess, Connie N. (författare)
- Univ Colorado, Sch Med, Dept Med, Div Cardiol, Aurora, CO USA.
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- Clare, Robert M. (författare)
- Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA.
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- Neely, Megan L. (författare)
- Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA.
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- Tricoci, Pierluigi (författare)
- Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA.;Duke Univ, Sch Med, Dept Med, Div Cardiol, Durham, NC 27706 USA.
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- Mahaffey, Kenneth W. (författare)
- Stanford Univ, Dept Med, Stanford, CA 94305 USA.
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- James, Stefan K, 1964- (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Alexander, John H. (författare)
- Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA.;Duke Univ, Sch Med, Dept Med, Div Cardiol, Durham, NC 27706 USA.
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- Held, Claes, 1956- (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Lopes, Renato D. (författare)
- Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA.;Duke Univ, Sch Med, Dept Med, Div Cardiol, Durham, NC 27706 USA.
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- Fox, Keith A. A. (författare)
- British Heart Fdn, Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland.
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- White, Harvey D. (författare)
- Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand.
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- Wallentin, Lars, 1943- (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Armstrong, Paul W. (författare)
- Univ Alberta, Div Cardiol, Edmonton, AB, Canada.
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- Harrington, Robert A. (författare)
- Stanford Univ, Dept Med, Stanford, CA 94305 USA.
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- Ohman, Erik Magnus (författare)
- Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA.;Duke Univ, Sch Med, Dept Med, Div Cardiol, Durham, NC 27706 USA.
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- Roe, Matthew T. (författare)
- Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA.;Duke Univ, Sch Med, Dept Med, Div Cardiol, Durham, NC 27706 USA.
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Univ Colorado, Sch Med, Dept Med, Div Cardiol, Aurora, CO USA Duke Clin Res Inst, 2400 Pratt St,Rm 031 1 Terrace Level, Durham, NC 27705 USA. (creator_code:org_t)
- MOSBY-ELSEVIER, 2017
- 2017
- Engelska.
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Ingår i: American Heart Journal. - : MOSBY-ELSEVIER. - 0002-8703 .- 1097-6744. ; 187, s. 194-203
- Relaterad länk:
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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
- Objective Acute coronary syndrome (ACS) trials typically use a composite primary outcome (myocardial infarction [MI], stroke, or cardiovascular death), but differential patient characteristics, timing, and consequences associated with individual component end points as first events have not been well studied. We compared patient characteristics and prognostic significance associated with first cardiovascular events in the post-ACS setting for initially stabilized patients. Methods We combined patient-level data from 4 trials of post-ACS antithrombotic therapies (PLATO, APPRAISE-2, TRACER, and TRILOGY ACS) to characterize the timing of and characteristics associated with first cardiovascular events (MI, stroke, or cardiovascular death). Landmark analysis at 7 days after index ACS presentation was used to focus on spontaneous, postdischarge events that were not confounded by in-hospital procedural complications. Using a competing risk framework, we tested for differential associations between prespecified covariates and the occurrence of nonfatal stroke vs MI as the first event, and we examined subsequent events after the first nonfatal event. Results Among 46,694 patients with a median follow-up of 358 (25th, 75th percentiles 262, 486) days, a first ischemic event occurred in 4,307 patients (9.2%) as follows: MI in 5.8% (n = 2,690), stroke in 1.0% (n = 477), and cardiovascular death in 2.4% (n = 1,140). Older age, prior stroke/transient ischemic attack, prior atrial fibrillation, and higher diastolic blood pressure were associated with a significantly greater risk of stroke vs MI, whereas prior percutaneous coronary intervention was associated with a greater risk of MI vs stroke. Second events occurred in 32% of those with a first nonfatal stroke at a median of 13 (3, 59) days after the first event and in 32% of those with a first nonfatal MI at a median of 35 (5, 137) days after the first event. The most common second event was a recurrent MI among those with MI as the first event and cardiovascular death among those with stroke as the first event. Conclusions Approximately 9% of patients experienced a first cardiovascular event in the post-ACS setting during a median follow-up of 1 year. Although the profile and prognostic implications of stroke vs MI as the first nonfatal event differ substantially, approximately one-third of these patients experienced a second event, typically soon after the first event. These findings have implications for improving post-ACS care and influencing the design of future cardiovascular trials.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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- Av författaren/redakt...
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Hess, Connie N.
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Clare, Robert M.
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Neely, Megan L.
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Tricoci, Pierlui ...
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Mahaffey, Kennet ...
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James, Stefan K, ...
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Alexander, John ...
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Held, Claes, 195 ...
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Lopes, Renato D.
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Fox, Keith A. A.
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White, Harvey D.
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Wallentin, Lars, ...
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Armstrong, Paul ...
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Harrington, Robe ...
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Ohman, Erik Magn ...
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Roe, Matthew T.
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kardiologi
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American Heart J ...
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Uppsala universitet