The 10th Biennial Hatter Cardiovascular Institute workshop: cellular protection—evaluating new directions in the setting of myocardial infarction, ischaemic stroke, and cardio-oncology

BackgroundIschaemic stroke and myocardial infarction (MI) are common after pneumonia and are associated with long-term mortality. Aspirin may attenuate this risk and should be explored as a therapeutic option.MethodsWe extracted all patients with pneumonia, aged over 50, from the Clinical Practice Research Datalink (CPRD), a large UK primary care database, from inception until January 2019. We then performed a prior event rate ratio analysis (PERR) with propensity score matching, an approach that allows for control of measured and unmeasured confounding, with aspirin usage as the exposure, and ischaemic events as the outcome. The primary outcome was the combined outcome of ischaemic stroke and myocardial infarction. Secondary outcomes were ischaemic stroke and myocardial infarction individually. Relevant confounders were included in the analysis (smoking, comorbidities, age, gender).Findings48 743 patients were eligible for matching. 8099 of these were aspirin users who were matched to 8099 non-users. Aspirin users had a reduced risk of the primary outcome (adjusted hazard ratio, HR 0.64; 95% confidence interval 0.52–0.79) in the PERR analysis. For both secondary outcomes, aspirin use was also associated with a reduced risk HR 0.46 (0.30–0.72) and HR 0.70 (0.55–0.91) for myocardial infarction and stroke respectively).InterpretationThis study provides supporting evidence that aspirin use is associated with reduced ischaemic events after pneumonia in a primary care setting. This drug may have a future clinical role in preventing this important complication.

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Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors

Acta Neurologica Scandinavica ◽

10.1111/ane.13135 ◽

2019 ◽

Vol 140 (3) ◽

pp. 219-228 ◽

Cited By ~ 1

Author(s):

Tiberiu A. Pana ◽

Adrian D. Wood ◽

Mamas A. Mamas ◽

Allan B. Clark ◽

Joao H. Bettencourt‐Silva ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Stroke Incidence

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Myocardial infarction, ischaemic stroke and pulmonary embolism before and after breast cancer hospitalisation

Thrombosis and Haemostasis ◽

10.1160/th10-12-0778 ◽

2011 ◽

Vol 106 (07) ◽

pp. 149-155 ◽

Cited By ~ 3

Author(s):

Sumitra Shantakumar ◽

Pieter W. Kamphuisen ◽

Fernie J. A. Penning-van Beest ◽

Ron M. C. Herings ◽

Myrthe P. P. van Herk-Sukel

Keyword(s):

Breast Cancer ◽

Myocardial Infarction ◽

Pulmonary Embolism ◽

Ischaemic Stroke ◽

Cancer Patients ◽

Breast Cancer Patients ◽

Increased Risk ◽

Before And After ◽

Receive Treatment ◽

Free Women

SummaryWe studied the occurrence of myocardial infarction (MI), ischaemic stroke (IS) and pulmonary embolism (PE) before and after breast cancer hospitalisation compared with cancer-free controls. For this, women with a first breast cancer hospitalisation during 2000–2007 were selected from the PHARMO Record Linkage System, including drug use and hospitalisations of three million inhabitants in the Netherlands, and matched 1:10 by age to cancer-free women. The occurrence of MI, IS and PE were assessed in the 12 months before and after breast cancer hospitalisation. The study included 11,473 breast cancer patients, with a mean (± SD) age of 59 (± 14) years. Breast cancer patients were two to three times as likely as their cancer-free controls to have had a hospitalisation for PE, MI or IS in the 12 months before diagnosis, though prevalence was <1% in all groups. Breast cancer patients experienced an extreme high risk of PE in the first six months after diag- nosis (hazard ratio [HR] 23.5, 95% confidence interval [CI] 11.1–49.7 compared to controls), which declined gradually to a four times increased risk (HR 3.6, 95%CI 2.4–5.5) more than 12 months after breast cancer hospitalisation. However, incidence was low: less than five events per 1,000 person years during all time periods. For MI and IS we did not observe significant increased HRs after breast cancer hospitalisation compared to controls. Breast cancer patients seem to have a higher risk profile to develop MI and IS, and receive treatment that increases the risk of PE compared to cancer-free controls, although the frequency of hospitalisations was low.

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The optimal drug adherence to maximize the efficacy and safety of non-vitamin K antagonist oral anticoagulant in real-world atrial fibrillation patients

EP Europace ◽

10.1093/europace/euz273 ◽

2019 ◽

Vol 22 (4) ◽

pp. 547-557 ◽

Cited By ~ 9

Author(s):

Daehoon Kim ◽

Pil-Sung Yang ◽

Eunsun Jang ◽

Hee Tae Yu ◽

Tae-Hoon Kim ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Clinical Outcomes ◽

Vitamin K ◽

Major Bleeding ◽

Oral Anticoagulant ◽

Vitamin K Antagonist ◽

Increased Risk ◽

Optimal Drug

Abstract Aims To investigate the association between adherence to non-vitamin K antagonist oral anticoagulant (NOAC) and clinical outcomes and to determine the optimal cut-off level of NOAC adherence among patients with atrial fibrillation (AF). Methods and results Using the Korean National Health Insurance Service database, we identified 96 197 patients with non-valvular AF who initiated NOAC or warfarin in 2013–16. We compared clinical outcomes between adherent [proportion of days covered (PDC) ≥80%] vs. non-adherent (PDC <80%) NOAC users, and further with warfarin users. We assessed the outcomes according to different levels of adherence. The proportion of adherent NOAC users was 64.0%. Compared with non-adherent NOAC users, adherent NOAC users were at lower risks of ischaemic stroke/systemic embolism (SE) [adjusted hazard ratio (aHR) 0.73, 95% confidence interval (CI) 0.69–0.79], and myocardial infarction (aHR 0.82, 95% CI 0.72–0.93), whereas there was no significant risk alteration for major bleeding (aHR 1.01, 95% CI 0.91–1.11). Compared with warfarin, non-adherent NOAC use failed to have better efficacy against ischaemic stroke/SE (aHR 0.99, 95% CI 0.93–1.05) and rather had increased risk of myocardial infarction (aHR 1.13, 95% CI 1.03–1.25). In NOAC users, the risks of adverse outcomes decreased according to gradual increase of adherence rates with the lowest risks in ≥90%, except for major bleeding in which there were no significant associations. Conclusions In an adherence level-dependent fashion, adherent use of NOAC showed better clinical outcomes without increasing bleeding risk. Maintaining ≥90% of adherence optimizes effectiveness of NOAC therapy without compromising its safety.

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Measuring the quality of care in small countries: the empirical analysis of 30-day mortality following acute myocardial infarction and ischaemic stroke in Latvia

Health Policy ◽

10.1016/j.healthpol.2020.05.017 ◽

2020 ◽

Vol 124 (7) ◽

pp. 695-700

Author(s):

Jacopo Lenzi ◽

Guido Noto ◽

Ilaria Corazza ◽

Jana Lepiksone ◽

Maria Pia Fantini

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Ischaemic Stroke ◽

Empirical Analysis ◽

Small Countries ◽

The Empirical Analysis

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Comparative effectiveness and safety of low-strength and high-strength direct oral anticoagulants compared with warfarin: a sequential cohort study

BMJ Open ◽

10.1136/bmjopen-2018-026486 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026486 ◽

Cited By ~ 4

Author(s):

Nicole L Pratt ◽

Emmae Ramsay ◽

Lisa M Kalisch Ellett ◽

Katherine Duszynski ◽

Sepehr Shakib ◽

...

Keyword(s):

Myocardial Infarction ◽

Cohort Study ◽

Propensity Score ◽

Ischaemic Stroke ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

High Strength ◽

Risk Of Bleeding ◽

Increased Risk ◽

Low Strength

ObjectivesThe aim of this study was to compare effectiveness and safety of low-strength and high-strength direct oral anticoagulants (DOACs) with warfarin in the Australian Veteran population.DesignSequential cohort study using inverse probability of treatment weighting (IPTW) and propensity score matching. Initiators of high-strength (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) and low-strength DOACS (apixaban 2.5 mg, dabigatran 110 mg, rivaroxaban 15 mg) were compared with warfarin initiators.SettingAustralian Government Department of Veterans’ Affairs claims database.Participants4836 patients who initiated oral anticoagulants (45.8%, 26.0% and 28.2% on low-strength, high-strength DOACs and warfarin, respectively) between August 2013 and March 2015. Mean age was 85, 75 and 83 years for low-strength, high-strength DOACs and warfarin initiators, respectively.Main outcome measuresOne-year risk of hospitalisation for ischaemic stroke, any bleeding event or haemorrhagic stroke. Secondary outcomes were 1-year risk of hospitalisation for myocardial infarction and death.ResultsUsing the IPTW method, no difference in risk of ischaemic stroke or bleeding was found with low-strength DOACs compared with warfarin. As a class, no increased risk of myocardial infarction was found for low-strength DOACs, however, risk was elevated for apixaban (HR 2.25, 95% CI 1.23 to 4.13). For high-strength DOACs, no difference was found for ischaemic stroke compared with warfarin, however, there was a significant reduction in risk of bleeding events (HR 0.63, 95% CI 0.44 to 0.89) and death (HR 0.40, 95% CI 0.28 to 0.58). Propensity score matching showed no difference in risk of ischaemic stroke or bleeding.ConclusionWe found that in the practice setting both DOAC formulations were similar to warfarin with regard to effectiveness and had no increased risk of bleeding.

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