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Errigo D, Saglietto A, Angelini F, Lip GYH, Lopes RD, Conrotto F, Omede PG, Montefusco A, Manzano-Fernandez S, Raposeiras-Rubin S, Varbella F, D'Amico M, D'Ascenzo F, Rinaldi M, Giustetto C. P2552Triple vs. double antithrombotic therapy in patients needing oral anticoagulation undergoing percutaneous coronary intervention: a meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The optimal antithrombotic therapy strategy in patients undergoing PCI who need OAC is currently debated.
Purpose
To determine the best regimen in terms of safety and efficacy.
Methods
We performed a meta-analysis of RCT and adjusted results reporting outcomes of patients who underwent PCI and were on TT or DAPT or DT. All-cause death was the primary end point, while MACE was the secondary outcome, along with its individual components, and major bleedings.
Results
15 studies encompassing 27070 patients were included. After a follow up of 12 (11–14) months, TT reduced all-cause death compared to DAPT (OR 0.52, 0.35–0.78), mainly driven by a lower incidence of MI (OR 0.81, 0.69–0.85) and stroke (OR 0.76, 0.56–1.03) despite higher rates of major bleedings (OR 2.81, 1.54–5.12). Comparing TT vs. DT with warfarin, all-cause death was non-significantly different (OR 1.23, 0.60–2.53), nor MI (OR 0.77, 0.23–2.59) and stroke (OR 4.01, 0.80–20.07), while major bleeding was increased with TT (OR 2.40, 1.34–4.38). When compared to DT with NOACs, TT did not reduce risk of MI (OR 0.96, 0.67–1.36) or stroke (OR 0.82, 0.55–1.24), but increased major bleedings (OR 1.98, 1.43–2.73). The non-randomized comparison between DT with warfarin and DT with NOACs showed a neutral effect on death and major bleedings, with similar rates also of MI (OR 0.47, 0.20–1.11, all CI 95%).
Conclusion
Double therapy with warfarin or with NOAC plus a single antiplatelet agent reduces the risk of major bleeding compared to triple therapy, with a neutral impact of subsequent ischemic events.
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Affiliation(s)
- D Errigo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - A Saglietto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - F Angelini
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - G Y H Lip
- Birmingham Heartlands Hospital, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK, Birimingham, United Kingdom
| | - R D Lopes
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Ca, Durham, United States of America
| | - F Conrotto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - P G Omede
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - A Montefusco
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - S Manzano-Fernandez
- University of Murcia, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Spain, Murcia, Spain
| | - S Raposeiras-Rubin
- Povisa Hospital, University Hospital Άlvaro Cunqueiro, Vigo, Spain, Vigo, Spain
| | | | - M D'Amico
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - F D'Ascenzo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - M Rinaldi
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
| | - C Giustetto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiovascular Medicine, Turin, Italy
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De Filippo O, D'Ascenzo F, Raposeiras-Roubin S, Peyracchia M, Gili S, Iannaccone M, Ariza-Sole A, Abu-Assi E, Liebetrau C, Manzano-Fernandez S, Montabone A, Henriques JPS, Quadri G, Giustetto C, Rinaldi M. P6409Ticagrelor and prasugrel versus clopidogrel in patients with acute coronary syndromes and chronic renal dysfunction: safety and efficacy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Safety and efficacy of prasugrel and ticagrelor in real-life ACS (Acute Coronary Syndrome) with renal dysfunction remain to be established.
Methods
Consecutive patients from RENAMI and BLEEMACS were stratified according to renal function and estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2). Myocardial infarction (MI) and BARC major bleedings (MB; BARC type 3 or 5) were the primary end-point. Independent impact of clopidogrel, prasugrel and ticagrelor were evaluated with Cox multivariate analysis.
Results
19255 patients were enrolled (mean eGFR: 90±39 ml/min/1.73m2). Patients with eGFR<60 mL/min/1.73m2, constituted the 12.9% of the population (2490 pts). After a mean follow up of 13±5 months, the global incidence of re-AMI was of 5.8% and 2.9% in patients with and in those without eGFR<60 mL/min/1.73m2 (p<0.0001) respectively. MB occurred in 5.7% and 3% (p<0.0001). At Cox multivariate analysis, clopidogrel compared to prasugrel and ticagrelor was associated with increased risk of MI both in those with eGFR>60 mL/min/1.73m2 (HR=3.3: 2.4–4.4, p<0.0001) as well as in patients with eGFR<60 mL/min/1.73m2 (HR=10.04: 3.1–32.3, p<0.0001). In contrast, both prasugrel (HR=0.07: 0.01–0.54, p=0.01) and Ticagrelor (HR=0.36: 0.16–0.81, p=0.01) were associated with decreased risk of MI in the latters. DAPT with ticagrelor or prasugrel did not increased risk of MB in patients with eGFR<60 mL/min/1.73m2, while in patients with eGFR>60 mL/min/1.73m2, ticagrelor was associated to a slightly higher risk of MB (HR=1.43: 1.09–1.89, p=0.009).
Conclusion
In ACS patients with eGFR<60 mL/min/1.73m2, prasugrel and ticagrelor are associated with lower risk of recurrent MI without significant increase in the risk of MB.
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Affiliation(s)
- O De Filippo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - F D'Ascenzo
- City of Health and Science of Turin, Turin, Italy
| | | | - M Peyracchia
- City of Health and Science of Turin, Turin, Italy
| | - S Gili
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - E Abu-Assi
- University Hospital Άlvaro Cunqueiro, vigo, Spain
| | - C Liebetrau
- Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | - A Montabone
- San Giovanni Bosco Hospital of Turino, Turin, Italy
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - G Quadri
- Degli Infermi Hospital, Rivoli, Italy
| | - C Giustetto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - M Rinaldi
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
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Cespon Fernandez M, Raposeiras Roubin S, Abu-Assi E, Manzano-Fernandez S, Dascenzo F, Simao Henriques JP, Saucedo J, Flores Blanco P, Cambronero Sanchez F, Ariza Sole A, Munoz Pousa I, Caneiro Queija B, Cobas Paz R, Lopez Rodriguez E, Iniguez Romo A. 461Modulation of ischemic and bleeding risk by peripheral artery disease after an acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with acute coronary syndrome (ACS). With this study from real-life patients, we try to analyze the balance between ischemic and bleeding risk during treatment with dual antiplatelet therapy (DAPT) after an ACS according to the presence or not of PAD.
Methods
The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without PAD. The impact of prior PAD in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal.
Results
From the 26,076 ACS patients, 1,600 have PAD (6.1%). Patients with PAD were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with PAD in comparison with the rest of the population (8.2% vs 22.8%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. After propensity-score matching, we obtained two matched groups of 1,591 patients. Patients with PAD showed a significant higher risk of both AMI (sHR 2.17, 95% CI 1.51–3.10, p<0.001) and MB (sHR 1.51, 95% CI 1.07–2.12, p=0.018), in comparison with those without PAD. The cumulative incidence of AMI was 63.9 and 29.8 per 1,000 patients/year in patients with and without PAD, respectively. The cumulative incidence of MB was 55.9 and 37.6 per 1,000 patients/year in patients with and without PAD, respectively. The rate difference per 1,000 patient-years for AMI between patients with and without PAD was +34.1 (95% CI 30.1–38.1), and for MB +18.3 (16.1–20.4). The net balance between ischemic and bleeding events comparing patients with and without PAD was positive (+15.8 per 1,000 patients/year, 95% CI 9.7–22.0).
Conclusions
PAD was associated with higher ischemic and bleeding risk after hospital discharge for ACS treated with DAPT. However, the balance between ischemic and bleeding risk was positive for patients with PAD in comparison with patients without PAD. As summary, ACS patients with PAD had an ischemic risk greater than the bleeding risk.
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Affiliation(s)
| | | | - E Abu-Assi
- University Hospital Alvaro Cunqueiro, Pontevedra, Spain
| | | | - F Dascenzo
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | | | - J Saucedo
- NorthShore University Hospital, Chicago, United States of America
| | - P Flores Blanco
- Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - A Ariza Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - I Munoz Pousa
- University Hospital Alvaro Cunqueiro, Pontevedra, Spain
| | | | - R Cobas Paz
- University Hospital Alvaro Cunqueiro, Pontevedra, Spain
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Fioravanti F, Bertaina M, D'Ascenzo F, Bongiovanni F, Raposeiras-Roubin S, Abu-Assi E, Kinnaird T, Ariza-Sole A, Manzano-Fernandez S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Rognoni A, Luscher TF. P3178Long vs. short dual antiplatelet therapy in ACS patients treated with prasugrel or ticagrelor and coronary revascularization: a propensity score analysis from the RENAMI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Fioravanti
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Department of Cardiology, Turin, Italy
| | - M Bertaina
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Department of Cardiology, Turin, Italy
| | - F D'Ascenzo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Department of Cardiology, Turin, Italy
| | - F Bongiovanni
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Department of Cardiology, Turin, Italy
| | | | - E Abu-Assi
- Hospital of Meixoeiro, Department of Cardiology, Vigo, Spain
| | - T Kinnaird
- University Hospital of Wales, Cardiology Department, Cardiff, United Kingdom
| | - A Ariza-Sole
- University Hospital of Bellvitge, Department of Cardiology, Barcelona, Spain
| | - S Manzano-Fernandez
- Hospital Clínico Univeristario Virgen de la Arrixaca, Department of Cardiology, Murcia, Spain
| | - C Templin
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
| | - L Velicki
- Institute of cardiovascular Diseases, Vojvodina, Serbia
| | | | - E Cerrato
- University Hospital of Bellvitge, Department of Cardiology, Barcelona, Spain
| | - A Rognoni
- Hospital Maggiore Della Carita, Novara, Italy
| | - T F Luscher
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
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De Filippo O, Raposeiras-Roubin S, Gili S, Abu-Assi E, Kinnaird T, Ariza-Sole A, Manzano-Fernandez S, Templin C, Xanthopoulou I, Cerrato E, Rognoni A, Boccuzzi G, Montefusco A, Iniguez-Romo A, D'Ascenzo F. P5588REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction (RENAMI). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O De Filippo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Medical sciences, Turin, Italy
| | | | - S Gili
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Medical sciences, Turin, Italy
| | - E Abu-Assi
- University Hospital Άlvaro Cunqueiro, Vigo, Spain
| | - T Kinnaird
- University Hospital of Wales, Cardiff, United Kingdom
| | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - C Templin
- University Heart Center, Zurich, Switzerland
| | | | - E Cerrato
- Degli Infermi Hospital, Rivoli, Italy
| | - A Rognoni
- Hospital Maggiore Della Carita, Novara, Italy
| | - G Boccuzzi
- San Giovanni Bosco Hospital of Turino, Turin, Italy
| | - A Montefusco
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Medical sciences, Turin, Italy
| | | | - F D'Ascenzo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Medical sciences, Turin, Italy
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Cobas-Paz R, Abu-Assi E, Raposeiras-Roubin S, Caneiro B, Manzano-Fernandez S, Flores-Blanco P, Cambronero-Sanchez F, Soto Loureiro F, Calvo-Iglesias F, Iniguez-Romo A, Valdes M. P6451Incidence, prognosis and predictors of post-discharge heart failure in acute myocardial infarction patients without left ventricular systolic dysfunction and/or history of heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Orenes-Pinero E, Marin F, Fernandez H, Manzano-Fernandez S, Vilchez JA, Gallego P, Valdes M, Vicente V, Lip GY, Roldan V. Renal adiponectin as a biomarker of kidney disease in stable anticoagulated atrial fibrillation patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Roldan V, Marin F, Vilchez JA, Dominguez V, Puche C, Romera M, Manzano-Fernandez S, Vicente V, Valdes M, Lip GY. Usefulness of N-terminal pro-B-type natriuretic peptide levels for stroke prediction in anticoagulated patients with atrial fibrillation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tello Montoliu A, Garcia-Salas JM, Casas T, Lopez Cuenca A, Perez-Berbel P, Manzano-Fernandez S, Marin F, Valdes M. Prognostic assessment in non-ST elevation acute coronary syndrome with negative troponin levels: a multimarker approach. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marin F, Vilchez JA, Roldan V, Manzano-Fernandez S, Fernandez H, Aviles F, Martinez-Hernandez P, Vicente V, Valdes M, Lip GY. Beta-trace protein and prognosis in anticoagulated patients with atrial fibrillation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Flores-Blanco P, Perez-Calvo JI, Ruiz-Ruiz FJ, Carrasco-Sanchez FJ, Morales-Rull JL, Galisteo-Almeda L, Montalban-Larrea S, Navarro-Penalver M, Valdes M, Manzano-Fernandez S. Complementary prognosis value of N-Terminal Pro-B-Type natriuretic peptide and CKD-EPI equations in acutely decompensated heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Ruiz-Nodar JM, Marin F, Sanchez-Paya J, Hurtado JA, Valencia-Martin J, Manzano-Fernandez S, Roldan V, Perez-Andreu V, Sogorb F, Valdes M, Lip GY. Efficacy and safety of drug-eluting stent use in patients with atrial fibrillation. Eur Heart J 2008; 30:932-9. [DOI: 10.1093/eurheartj/ehp045] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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