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Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction
OBJECTIVE: In patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors u...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662954/ https://www.ncbi.nlm.nih.gov/pubmed/31055499 http://dx.doi.org/10.1136/heartjnl-2018-314590 |
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author | Lindholm, Daniel Sarno, Giovanna Erlinge, David Svennblad, Bodil Hasvold, Lars Pål Janzon, Magnus Jernberg, Tomas James, Stefan K |
author_facet | Lindholm, Daniel Sarno, Giovanna Erlinge, David Svennblad, Bodil Hasvold, Lars Pål Janzon, Magnus Jernberg, Tomas James, Stefan K |
author_sort | Lindholm, Daniel |
collection | PubMed |
description | OBJECTIVE: In patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors using nationwide registries. METHODS: Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, patients with invasively managed MI in 2006–2014 were included. Six factors were assessed in relation to cardiovascular death (CVD)/MI/stroke, and major bleeding: age ≥65, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI. RESULTS: We studied 100 879 patients, of whom 20 831 (20.6%) experienced CVD/MI/stroke and 5939 (5.9%) major bleeding, during 3.6 years median follow-up. In adjusted Cox models, all factors were associated with CVD/MI/stroke, and all but prior MI were associated with major bleeding. The majority (53.5%) had ≥2 risk factors. With each added risk factor, there was a marked but gradual increase in incidence of the CVD/MI/stroke. This was seen also for major bleeding, but to a lesser extent, largely driven by prior bleeding as the strongest risk factor. CONCLUSIONS: The majority of patients with MI had two or more established risk factors. Increasing number of risk factors was associated with higher rate of ischaemic events. When excluding patients with prior major bleeding, bleeding incidence rate increased only minimally with increasing number of risk factors. The high ischaemic risk in those with multiple risk factors highlights an unmet need for additional preventive measures. |
format | Online Article Text |
id | pubmed-6662954 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-66629542019-08-12 Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction Lindholm, Daniel Sarno, Giovanna Erlinge, David Svennblad, Bodil Hasvold, Lars Pål Janzon, Magnus Jernberg, Tomas James, Stefan K Heart Coronary Artery Disease OBJECTIVE: In patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors using nationwide registries. METHODS: Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, patients with invasively managed MI in 2006–2014 were included. Six factors were assessed in relation to cardiovascular death (CVD)/MI/stroke, and major bleeding: age ≥65, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI. RESULTS: We studied 100 879 patients, of whom 20 831 (20.6%) experienced CVD/MI/stroke and 5939 (5.9%) major bleeding, during 3.6 years median follow-up. In adjusted Cox models, all factors were associated with CVD/MI/stroke, and all but prior MI were associated with major bleeding. The majority (53.5%) had ≥2 risk factors. With each added risk factor, there was a marked but gradual increase in incidence of the CVD/MI/stroke. This was seen also for major bleeding, but to a lesser extent, largely driven by prior bleeding as the strongest risk factor. CONCLUSIONS: The majority of patients with MI had two or more established risk factors. Increasing number of risk factors was associated with higher rate of ischaemic events. When excluding patients with prior major bleeding, bleeding incidence rate increased only minimally with increasing number of risk factors. The high ischaemic risk in those with multiple risk factors highlights an unmet need for additional preventive measures. BMJ Publishing Group 2019-08 2019-05-04 /pmc/articles/PMC6662954/ /pubmed/31055499 http://dx.doi.org/10.1136/heartjnl-2018-314590 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Coronary Artery Disease Lindholm, Daniel Sarno, Giovanna Erlinge, David Svennblad, Bodil Hasvold, Lars Pål Janzon, Magnus Jernberg, Tomas James, Stefan K Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction |
title | Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction |
title_full | Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction |
title_fullStr | Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction |
title_full_unstemmed | Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction |
title_short | Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction |
title_sort | combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction |
topic | Coronary Artery Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662954/ https://www.ncbi.nlm.nih.gov/pubmed/31055499 http://dx.doi.org/10.1136/heartjnl-2018-314590 |
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