Abstract:
:Background Early discontinuation of P2Y12 antagonists post-percutaneous coronary intervention may increase risk of stent thrombosis or nonstent recurrent myocardial infarction. Our aims were to (1) analyze the early discontinuation rate of P2Y12 antagonists post-percutaneous coronary intervention, (2) explore factors associated with early discontinuation, and (3) analyze the risk of major adverse cardiovascular events (death, acute coronary syndrome, revascularization, or stroke) associated with discontinuation from a prespecified prescribing instruction of 1 year. Method and Results We studied 2090 patients (2011-2015) who were recommended for clopidogrel for 12 months (+aspirin) post-percutaneous coronary intervention within a retrospective observational population cohort. Relationships between clopidogrel discontinuation and major adverse cardiac events were evaluated over 18-month follow-up. Discontinuation of clopidogrel in the first 4 quarters was low at 1.1%, 2.6%, 3.7%, and 6.1%, respectively. Previous revascularization, previous ischemic stroke, and age >80 years were independent predictors of early discontinuation. In a time-dependent multiple regression model, clopidogrel discontinuation and bleeding (hazard ratio=1.82 [1.01-3.30] and hazard ratio=5.30 [3.14-8.94], respectively) were independent predictors of major adverse cardiac events as were age <49 and ≥70 years (versus those aged 50-59 years), hypertension, chronic kidney disease stage 4+, previous revascularization, ischemic stroke, and thromboembolism. Furthermore, in those with both bleeding and clopidogrel discontinuation, hazard ratio for major adverse cardiac events was 9.34 (3.39-25.70). Conclusions Discontinuation of clopidogrel is low in the first year post-percutaneous coronary intervention, where a clear discharge instruction to treat for 1 year is provided. Whereas this is reassuring from the population level, at an individual level discontinuation earlier than the intended duration is associated with an increased rate of adverse events, most notably in those with both bleeding and discontinuation.
journal_name
J Am Heart Assocjournal_title
Journal of the American Heart Associationauthors
Harris DE,Lacey A,Akbari A,Obaid DR,Smith DA,Jenkins GH,Barry JP,Gravenor MB,Halcox JPdoi
10.1161/JAHA.119.012812subject
Has Abstractpub_date
2019-11-05 00:00:00pages
e012812issue
21issn
2047-9980journal_volume
8pub_type
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journal_title:Journal of the American Heart Association
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abstract::Background We aim to generate a line of "universal donor" human induced pluripotent stem cells (hi PSC s) that are nonimmunogenic and, therefore, can be used to derive cell products suitable for allogeneic transplantation. Methods and Results hi PSC s carrying knockout mutations for 2 key components (β2 microglobulin ...
journal_title:Journal of the American Heart Association
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doi:10.1161/JAHA.118.010239
更新日期:2018-12-04 00:00:00
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journal_title:Journal of the American Heart Association
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journal_title:Journal of the American Heart Association
pub_type: 杂志文章,多中心研究
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abstract:BACKGROUND:The volume-outcome relationship associated with intensive care unit (ICU) experience with managing acute myocardial infarction (AMI) remains inadequately understood. METHODS AND RESULTS:Within a multicenter clinical ICU database, we identified patients with a primary ICU admission diagnosis of AMI between 2...
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pub_type: 杂志文章,多中心研究
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abstract::Background Ankle-brachial indexes (ABI) are a noninvasive diagnostic tool for peripheral arterial disease and a marker of increased cardiovascular risk. ABI is calculated using the highest systolic blood pressure of the 4 ankle arteries (bilateral dorsalis pedis and posterior tibial). Accordingly, patients may be assi...
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pub_type: 杂志文章,随机对照试验
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更新日期:2018-08-21 00:00:00
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journal_title:Journal of the American Heart Association
pub_type: 临床试验,杂志文章
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更新日期:2016-10-31 00:00:00
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更新日期:2017-09-22 00:00:00
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pub_type: 杂志文章
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更新日期:2016-02-12 00:00:00
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pub_type: 杂志文章
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更新日期:2019-02-19 00:00:00
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pub_type: 杂志文章
doi:10.1161/JAHA.118.010890
更新日期:2019-07-02 00:00:00
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pub_type: 杂志文章
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更新日期:2020-01-07 00:00:00