Third-Generation P2Y12 Inhibitors in East Asian Acute Myocardial Infarction Patients: A Nationwide Prospective Multicentre Study

2018 ◽  
Vol 118 (03) ◽  
pp. 591-600 ◽  
Author(s):  
Jeehoon Kang ◽  
Jung-Kyu Han ◽  
Youngkeun Ahn ◽  
Shung Chull Chae ◽  
Young Jo Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
East Asian ◽  
Antiplatelet Agent ◽  
Third Generation ◽  
Bleeding Events ◽  
Cox Regression Analysis ◽  
P2y12 Inhibitors ◽  
All Cause Mortality

AbstractThird-generation P2Y12 inhibitors (prasugrel, ticagrelor) are recommended in acute myocardial infarction (AMI). We aimed to evaluate the efficacy and safety of third-generation P2Y12 inhibitors in East Asian AMI patients. From the Korean AMI Registry, 9,355 patients who received dual antiplatelet agent (aspirin with clopidogrel [AC], 6,444 [70.5%] patients; aspirin with prasugrel [AP], 1,100 [11.8%] patients; or aspirin with ticagrelor [AT], 1,811 [19.4%] patients) were analysed. In-hospital endpoints were all-cause mortality or bleeding events during admission and 1-year endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events. Regarding in-hospital events, AP and AT showed similar all-cause mortality rates but higher bleeding event rates compared with AC. This trend was extended to 1-year endpoints; Cox regression analysis showed that third-generation P2Y12 inhibitors had significantly higher bleeding risk (AP vs. AC: hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.53–2.99; p < 0.001; AT vs. AC: HR, 2.26; 95% CI, 1.73–2.95; p < 0.001). A propensity score matched triplet of 572 patients showed similar 1-year MACCE and higher bleeding events with third-generation P2Y12 inhibitors (2.1 vs. 2.6 vs. 2.1%, p = 0.790 for MACCE and 3.1 vs. 8.0 vs. 8.0%, p < 0.001 for bleeding events, in AC, AP and AT groups, respectively). Inverse probability weighted regression analysis and pooled analysis after randomly imputing missing variables showed consistent results. Collectively, prasugrel and ticagrelor showed similar rates of 1-year MACCE, but a higher rate of bleeding events, compared with clopidogrel in Korean AMI patients. Further studies are warranted to adapt Western guidelines on third-generation P2Y12 inhibitors for East Asians.

Prasugrel vs clopidogrel in cardiogenic shock patients undergoing primary PCI for acute myocardial infarction

2014 ◽  
Vol 112 (12) ◽  
pp. 1190-1197 ◽  
Author(s):  
Tanja Morath ◽  
Isabell Bernlochner ◽  
Martin Hadamitzky ◽  
Siegmund Braun ◽  
Stefanie Schulz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Primary Pci ◽  
Bleeding Events ◽  
All Cause Mortality ◽  
Clopidogrel Therapy ◽  
Function Testing ◽  
Lower Mortality Risk ◽  
High Risk Cohort

SummaryThere is limited clinical data comparing different P2Y12-receptor inhibitors in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. The aim of the ISAR-SHOCK registry was to compare the clinical outcome of patients treated with clopidogrel vs prasugrel in this setting. Patients (n=145) with AMI complicated by cardiogenic shock and undergoing primary PCI in two centres (Deutsches Herzzentrum München and Klinikum rechts der Isar, Technical University Munich) between January 2009 and May 2012 were included in this registry. The use of prasugrel for patients within this registry reflected co-morbidities and platelet function testing results during the acute AMI phase. Early outcome at 30-days was reported with regard to all-cause mortality, myocardial infarction (MI), stent thrombosis (ST) and bleeding events. With regard to antiplatelet treatment in the 145 cardiogenic shock patients, 50 patients were initially treated or immediately switched to prasugrel while 95 patients were treated with clopidogrel. All-cause mortality was lower in prasugrelvs clopidogrel-treated patients (30 % vs 50.5%, HR: 0.51, 95% CI [0.29–0.92], p=0.025). No significant differences in prasugrel- vs clopidogrel-treated patients were observed for the occurrence of MI (p=0.233), ST (p=0.306) or TIMI major bleedings (p=0.571). Results of the ISAR-SHOCK registry suggest that the use of prasugrel in AMI patients complicated by cardiogenic shock might be associated with a lower mortality risk as compared to clopidogrel therapy without increasing the risk of bleeding. These findings, however, need confirmation from specifically designed randomised studies in this high-risk cohort of patients.

scholarly journals The association between plasma furin and cardiovascular events after acute myocardial infarction

2020 ◽  
Author(s):  
Zhi-wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background: Furin is the key enzyme to cleave pro-BNP and plays a critical role in the cardiovascular system through its involvement in the lipid metabolism, blood pressure and formation of atheromatous plaques. NT-proBNP and recently corin, which is also a key enzyme to cleave pro-BNP, have been approved as predictors of prognosis after acute myocardial infarction (AMI). We here conducted this cohort study to investigate the relationship between plasma furin and the prognosis outcome in patients after AMI. Methods: We enrolled 1100 AMI patients and measured their plasma furin concentration. The primary endpoint was the major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction or non-fatal stroke. The association of plasma furin concentration with AMI outcomes was explored by using Kaplan–Meier curve and multivariate Cox regression analysis. Results: Our results showed that slight increase of mean cTNT in patients with higher furin concentration (P=0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis suggested that plasma furin was not associated with MACE (HR: 1.01; 95% CI: 0.93-1.06; P=0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR: 1.09; 95% CI: 1.01-1.17; P=0.022) after fully adjustment. Subgroup analysis indicated no relationship between plasma furin and MACE in different subgroup populations.Conclusions: Our study demonstrated that plasma furin was not associated with risk of MACE and may not be used as a predictor of poor prognosis after AMI. But higher levels of plasma furin may be associated with higher risk of non-fatal MI.

scholarly journals The association between plasma furin and cardiovascular events after acute myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi-Wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background Furin is the key enzyme involved in the cleavage of pro-BNP and plays a critical role in the cardiovascular system through its involvement in lipid metabolism, blood pressure regulation and the formation of atheromatous plaques. NT-proBNP and recently, corin, also a key enzyme in the cleavage of pro-BNP, have been accepted as predictors of prognosis after acute myocardial infarction (AMI). This cohort study was conducted to investigate the relationship between plasma furin and the prognostic outcomes of AMI patients. Methods In total, 1100 AMI patients were enrolled in the study and their plasma furin concentrations were measured. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke. The associations between plasma furin concentration and AMI outcomes were explored using Kaplan–Meier curves and multivariate Cox regression analysis. Results The results showed a slight increase in mean cTNT in patients with higher furin concentrations (P = 0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis indicated that plasma furin was not significantly associated with MACE (HR 1.01; 95% CI 0.93–1.06; P = 0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR 1.09; 95% CI 1.01–1.17; P = 0.022) in the fully adjusted model. Subgroup analyses indicated no relationship between plasma furin and MACE in different subgroups. Conclusions This study found no association between plasma furin and risk of MACE. Thus, plasma furin may not be a useful predictor of poor prognosis after AMI. However, higher levels of plasma furin may be associated with a higher risk of recurrent non-fatal MI.

scholarly journals Outcome of Prolonged Cardiac Arrest Under Extracorporeal Cardiopulmonary Resuscitation Due to Acute Myocardial Infarction: Complete vs Culprit Revascularization

2020 ◽  
Author(s):  
Hsi-Yu Yu ◽  
Chih-Hsien Wang ◽  
Lian-Yu Lin ◽  
Jou-Wei Lin ◽  
Nai-Hsin Chi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Regression Analysis ◽  
Risk Factor ◽  
Hospital Discharge ◽  
Low Flow ◽  
Cox Regression Analysis ◽  
Neurological Outcomes ◽  
One Year

Abstract Background: Immediate revascularization of infarct-related vessel (culprit strategy) is effective in patients with acute myocardial infarction (AMI) with cardiogenic shock. However, for AMI patients complicated with prolonged cardiac arrest under extracorporeal membrane oxygenation resuscitation (ECPR), whether culprit revascularization (IR) or complete revascularization (CR) is associated with better clinical outcome is not known. Methods: Patients with AMI complicated with prolonged cardiac arrest under ECMO support between 2006 and 2016 were included and were grouped by the status of revascularization completeness in three coronary territories into IR and CR groups. The primary endpoint is favorable neurological outcomes at hospital discharge. The second endpoint is the probability of a composite of major adverse cardiac and cerebral events (MACCE) at 1-year follow-up. Results: A total of 90 patients (32 IR and 58 CR) were included. Favorable neurological outcomes at hospital discharge were 21.9% and 37.9% in IR and CR patients, respectively (P = 0.121.) Multivariate logistic regression analysis did not reveal CR a significant risk factor (odds ratio: 1.82, 95% confidence interval [CI]: 0.70–4.77, P = 0.221). One-year freedom from MACCE probabilities were 24.6% and 42.4% in IR and CR patients, respectively (P = 0.051.) Cox regression analysis revealed that CR, in addition to age, low-flow duration, and initial shockable rhythm, was a risk factor (hazard ratio: 0.53, 95% CI: 0.31–0.91, P = 0.020). Conclusion: For patients with AMI under ECPR, culprit strategy had similar result to that of CR strategy in one-year outcome.

Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the Apolipoprotein-related Mortality RISk (AMORIS) Study

2010 ◽  
Vol 69 (11) ◽  
pp. 1996-2001 ◽  
Author(s):  
A G Semb ◽  
T K Kvien ◽  
A H Aastveit ◽  
I Jungner ◽  
T R Pedersen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Ischaemic Stroke ◽  
Mortality Risk ◽  
Predictive Value ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Related Mortality

ObjectivesTo examine the rates of acute myocardial infarction (AMI) and ischaemic stroke (IS) and to examine the predictive value of total cholesterol (TC) and triglycerides (TG) for AMI and IS in patients with rheumatoid arthritis (RA) and people without RA.MethodsIn the Apolipoprotein MOrtality RISk (AMORIS) Study 480 406 people (including 1779 with RA, of whom 214 had an AMI and 165 an IS) were followed for 11.8 (range 7–17) years. Cox regression analysis was used to calculate HR per SD increase in TC or TG with 95% CI. All values were adjusted for age, diabetes and hypertension.ResultsThe levels of TC and TG were significantly lower in patients with RA than in people without RA. Despite this, the rate of AMI and IS per 1000 years was at least 1.6 times higher in RA than non-RA. TC was nearly significantly predictive for AMI (HR/SD 1.13 (95% CI 0.99 to 1.29), p=0.07) and significantly predictive for future IS in RA (HR/SD 1.20 (95% CI 1.03 to 1.40), p=0.02). TG had no relationship to development of AMI (1.07, 0.94 to 1.21, p=0.29), but was weakly related to IS (1.13, 0.99 to 1.27, p=0.06). In contrast, both TC and TG were significant predictors of AMI and IS in people without RA.ConclusionsPatients with RA had 1.6 times higher rate of AMI and IS than people without RA. TC and TG were significant predictors of AMI and IS in people without RA, whereas the predictive value in RA was not consistent.

scholarly journals Bleeding in cardiac patients prescribed antithrombotic drugs: electronic health record phenotyping algorithms, incidence, trends and prognosis

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Laura Pasea ◽  
Sheng-Chia Chung ◽  
Mar Pujades-Rodriguez ◽  
Anoop D. Shah ◽  
Samantha Alvarez-Madrazo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Electronic Health Record ◽  
Stable Angina ◽  
Health Record ◽  
Bleeding Events ◽  
All Cause Mortality ◽  
Electronic Health

Abstract Background Clinical guidelines and public health authorities lack recommendations on scalable approaches to defining and monitoring the occurrence and severity of bleeding in populations prescribed antithrombotic therapy. Methods We examined linked primary care, hospital admission and death registry electronic health records (CALIBER 1998–2010, England) of patients with newly diagnosed atrial fibrillation, acute myocardial infarction, unstable angina or stable angina with the aim to develop algorithms for bleeding events. Using the developed bleeding phenotypes, Kaplan-Meier plots were used to estimate the incidence of bleeding events and we used Cox regression models to assess the prognosis for all-cause mortality, atherothrombotic events and further bleeding. Results We present electronic health record phenotyping algorithms for bleeding based on bleeding diagnosis in primary or hospital care, symptoms, transfusion, surgical procedures and haemoglobin values. In validation of the phenotype, we estimated a positive predictive value of 0.88 (95% CI 0.64, 0.99) for hospitalised bleeding. Amongst 128,815 patients, 27,259 (21.2%) had at least 1 bleeding event, with 5-year risks of bleeding of 29.1%, 21.9%, 25.3% and 23.4% following diagnoses of atrial fibrillation, acute myocardial infarction, unstable angina and stable angina, respectively. Rates of hospitalised bleeding per 1000 patients more than doubled from 1.02 (95% CI 0.83, 1.22) in January 1998 to 2.68 (95% CI 2.49, 2.88) in December 2009 coinciding with the increased rates of antiplatelet and vitamin K antagonist prescribing. Patients with hospitalised bleeding and primary care bleeding, with or without markers of severity, were at increased risk of all-cause mortality and atherothrombotic events compared to those with no bleeding. For example, the hazard ratio for all-cause mortality was 1.98 (95% CI 1.86, 2.11) for primary care bleeding with markers of severity and 1.99 (95% CI 1.92, 2.05) for hospitalised bleeding without markers of severity, compared to patients with no bleeding. Conclusions Electronic health record bleeding phenotyping algorithms offer a scalable approach to monitoring bleeding in the population. Incidence of bleeding has doubled in incidence since 1998, affects one in four cardiovascular disease patients, and is associated with poor prognosis. Efforts are required to tackle this iatrogenic epidemic.

Practical guidance for P2Y12 inhibitors in acute myocardial infarction undergoing percutaneous coronary intervention

2020 ◽  
Author(s):  
Seung Hun Lee ◽  
Hyun Kuk Kim ◽  
Myung Ho Jeong ◽  
Satoshi Yasuda ◽  
Satoshi Honda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Scoring System ◽  
Bleeding Risk ◽  
Health Study ◽  
Bleeding Events ◽  
P2y12 Inhibitors ◽  
Derivation Cohort ◽  
New Scoring ◽  
Selection Of

Abstract Aims Potent P2Y12 inhibitors for dual antiplatelet therapy (DAPT) is crucial for managing acute myocardial infarction; however, the selection of drugs is based on limited clinical information such as age and body weight. The current study sought to develop and validate a new risk scoring system that can be used to guide the selection of potent P2Y12 inhibitors by balancing ischaemic benefit and bleeding risk. Methods and results Derivation cohort of 10 687 patients who participated in the Korea Acute Myocardial Infarction Registry-National Institutes of Health study was used to construct a new scoring system. We combined the ischaemic and bleeding models to establish a simple clinical prediction score. Among the low score group (n = 1764), the observed bleeding risk (8.7% vs. 4.4%, P &lt; 0.001) due to potent P2Y12 inhibitors exceeded ischaemic benefit (1.3% vs. 2.2%, P = 0.185) during 12 months. Conversely, the high score group (n = 1898) showed an overall benefit from taking potent P2Y12 inhibitors from the standpoint of observed ischaemic (17.1% vs. 8.6%, P &lt; 0.001) and bleeding events (10.1% vs. 6.8%, P = 0.073). The performance of ischaemic [integrated area under the curve (iAUC) = 0.809] and bleeding model (iAUC = 0.655) was deemed to be acceptable. Conclusion The new scoring system is a useful clinical tool for guiding DAPT by balancing ischaemic benefit and bleeding risk, especially among Asian populations. Further validation studies with other cohorts will be required to verify that the new system meets the needs of real clinical practice.

scholarly journals The Association Between Plasma Furin and Cardiovascular Events After Acute Myocardial Infarction

2020 ◽  
Author(s):  
Zhi-wei Liu ◽  
Qiang Ma ◽  
Jie Liu ◽  
Jing-Wei Li ◽  
Yun-Dai Chen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Critical Role ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Atheromatous Plaques ◽  
Key Enzyme

Abstract Background: Furin is the key enzyme to cleave pro-BNP, and plays a critical role in the cardiovascular system through its involvement in the lipid metabolism, blood pressure and formation of atheromatous plaques. NT-proBNP and recently corin, which is also a key enzyme to cleave pro-BNP, have been approved as predictors of prognosis after acute myocardial infarction (AMI). We here conducted this prospective cohort study to investigate the relationship between plasma furin and the prognosis outcome in patients after AMI. Methods: We enrolled 1100 AMI patients and measured their plasma furin concentration. The primary endpoint was the major adverse cardiac events (MACE), a composite of cardiovascular (CV) death, non-fatal myocardial infarction or non-fatal stroke. The association of plasma furin concentration with AMI outcomes was explored by using Kaplan–Meier curve and multivariate Cox regression analysis. Results: Our results showed that slight increase of mean cTNT in patients with higher furin concentration (P=0.016). Over a median follow-up of 31 months, multivariate Cox regression analysis suggested that plasma furin was not associated with MACE (HR: 1.01; 95% CI: 0.93-1.06; P=0.807) after adjustment for potential conventional risk factors. However, plasma furin was associated with non-fatal MI (HR: 1.09; 95% CI: 1.01-1.17; P=0.022) after fully adjustment. Subgroup analysis indicated no relationship between plasma furin and MACE in different subgroup populations.Conclusions: Our study demonstrated that plasma furin was not associated with risk of MACE and may not be used as a predictor of poor prognosis after AMI. But higher levels of plasma furin may be associated with higher risk of non-fatal MI, future studies are needed to verify this.

scholarly journals Legumain is a predictor of all-cause mortality and potential therapeutic target in acute myocardial infarction

2020 ◽  
Vol 11 (11) ◽  
Author(s):  
Hui Yang ◽  
Yuhu He ◽  
Pu Zou ◽  
Yilei Hu ◽  
Xuping Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Interquartile Range ◽  
Prognostic Impact ◽  
Healthy Controls ◽  
Operating Characteristics ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Ecm Degradation

AbstractThe prognostic impact of extracellular matrix (ECM) modulation and its regulatory mechanism post-acute myocardial infarction (AMI), require further clarification. Herein, we explore the predictive role of legumain—which showed the ability in ECM degradation—in an AMI patient cohort and investigate the underlying mechanisms. A total of 212 AMI patients and 323 healthy controls were enrolled in the study. Moreover, AMI was induced in mice by permanent ligation of the left anterior descending artery and fibroblasts were adopted for mechanism analysis. Based on the cut-off value for the receiver-operating characteristics curve, AMI patients were stratified into low (n = 168) and high (n = 44) plasma legumain concentration (PLG) groups. However, PLG was significantly higher in AMI patients than that in the healthy controls (median 5.9 μg/L [interquartile range: 4.2–9.3 μg/L] vs. median 4.4 μg/L [interquartile range: 3.2–6.1 μg/L], P < 0.001). All-cause mortality was significantly higher in the high PLG group compared to that in the low PLG group (median follow-up period, 39.2 months; 31.8% vs. 12.5%; P = 0.002). Multivariate Cox regression analysis showed that high PLG was associated with increased all-cause mortality after adjusting for clinical confounders (HR = 3.1, 95% confidence interval (CI) = 1.4–7.0, P = 0.005). In accordance with the clinical observations, legumain concentration was also increased in peripheral blood, and infarcted cardiac tissue from experimental AMI mice. Pharmacological blockade of legumain with RR-11a, improved cardiac function, decreased cardiac rupture rate, and attenuated left chamber dilation and wall thinning post-AMI. Hence, plasma legumain concentration is of prognostic value in AMI patients. Moreover, legumain aggravates cardiac remodelling through promoting ECM degradation which occurs, at least partially, via activation of the MMP-2 pathway.

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