scholarly journals Low adherence to statin treatment during the 1st year after an acute myocardial infarction is associated with increased 2nd-year mortality risk—an inverse probability of treatment weighted study on 54 872 patients

2020 ◽  
Author(s):  
Kani Khalaf ◽  
Kristina Johnell ◽  
Peter C Austin ◽  
Patrik Tyden ◽  
Patrik Midlöv ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Real World ◽  
Statin Treatment ◽  
Term Survival ◽  
Inverse Probability ◽  
The Real ◽  
Real World Setting ◽  
Increased Risk ◽  
Cvd Mortality

Abstract Aims Experiencing an acute myocardial infarction (AMI) is a life-threatening event and use of statins can reduce the probability of recurrence and improve long-term survival. However, the effectiveness of statins in the real-world setting may be lower than the reported efficacy in randomized clinical trials. Therefore, we aimed to investigate whether low statin treatment adherence during the year following an AMI episode is associated with increased 2nd-year mortality. Methods and results We analysed all 54 872 AMI patients aged ≥45 years, admitted to Swedish hospitals between 2010 and 2012, and who survive at least 1 year after the AMI episode. We defined low adherence as a medication possession ratio <50% or non-use of statins. Applying inverse probability of treatment weighting (IPTW), we investigated the association between low adherence and all-cause, cardiovascular disease (CVD), and non-CVD mortality during the 2nd year. Overall, 20% of the patients had low adherence during the 1st year and 8% died during the 2nd year. In the IPTW analysis, low adherence was associated with an increased risk of all-cause [absolute risk difference (ARD) = 0.048, number needed to harm (NNH) = 21, relative risk (RR) = 1.71], CVD (ARD = 0.035, NNH = 29, RR = 1.62), and non-CVD mortality (ARD = 0.013, NNH = 77, RR = 2.17). Conclusion In the real-world setting, low statin adherence during the 1st year after an AMI episode is associated with increased mortality during the 2nd year. Our results reaffirm the importance of achieving a high adherence to statin treatment after suffering from an AMI.

Tofacitinib and risk of cardiovascular outcomes: results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) study

2022 ◽  
pp. annrheumdis-2021-221915
Author(s):  
Farzin Khosrow-Khavar ◽  
Seoyoung C Kim ◽  
Hemin Lee ◽  
Su Been Lee ◽  
Rishi J Desai
Keyword(s):  
Rheumatoid Arthritis ◽  
Real World ◽  
Fixed Effects ◽  
Safety Concern ◽  
Specific Effect ◽  
Routine Care ◽  
Cardiovascular Outcomes ◽  
The Real ◽  
Real World Setting ◽  
Increased Risk

ObjectivesRecent results from ‘ORAL Surveillance’ trial have raised concerns regarding the cardiovascular safety of tofacitinib in patients with rheumatoid arthritis (RA). We further examined this safety concern in the real-world setting.MethodsWe created two cohorts of patients with RA initiating treatment with tofacitinib or tumour necrosis factor inhibitors (TNFI) using deidentified data from Optum Clinformatics (2012–2020), IBM MarketScan (2012–2018) and Medicare (parts A, B and D, 2012–2017) claims databases: (1) A ‘real-world evidence (RWE) cohort’ consisting of routine care patients and (2) A ‘randomised controlled trial (RCT)-duplicate cohort’ mimicking inclusion and exclusion criteria of the ORAL surveillance trial to calibrate results against the trial findings. Cox proportional hazards models with propensity score fine stratification weighting were used to estimate HR and 95% CIs for composite outcome of myocardial infarction and stroke and accounting for 76 potential confounders. Database-specific effect estimates were pooled using fixed effects models with inverse-variance weighting.ResultsIn the RWE cohort, 102 263 patients were identified of whom 12 852 (12.6%) initiated tofacitinib. The pooled weighted HR (95% CI) comparing tofacitinib with TNFI was 1.01 (0.83 to 1.23) in RWE cohort and 1.24 (0.90 to 1.69) in RCT-duplicate cohort which aligned closely with ORAL-surveillance results (HR: 1.33, 95% CI 0.91 to 1.94).ConclusionsWe did not find evidence for an increased risk of cardiovascular outcomes with tofacitinib in patients with RA treated in the real-world setting; however, tofacitinib was associated with an increased risk of cardiovascular outcomes, although statistically non-significant, in patients with RA with cardiovascular risk factors.Trial registration numberNCT04772248.

P4629Long-term outcomes in patients with ST-segment elevation myocardial infarction according to modalities of reperfusion therapy: data from china acute myocardial infarction (CAMI) registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
X J Gao ◽  
J G Yang ◽  
Y J Yang ◽  
C Wu ◽  
S B Qiao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Real World ◽  
Symptom Onset ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Real World Setting ◽  
St Segment ◽  
The Impact

Abstract Background Although primary percutaneous coronary intervention (pPCI) is the optimal reperfusion method for ST-segment elevation myocardial infarction (STEMI), it remains difficult to implement in many areas. Some STEMI patients have to accept fibrinolytic therapy and no reperfusion therapy instead. Purpose The aim of this study was to describe the impact of reperfusion therapy on the long-term outcomes of STEMI patients in China. Methods Using data from the China Acute Myocardial Infarction (CAMI) registry, we analyzed the 2-year outcomes of 18,075 STEMI patients symptom onset within 7 days from January 2013 to September 2014 according to the type of reperfusion therapy. The primary endpoint was a composite of major adverse cardiovascular event (MACE), defined as all-cause mortality, myocardial infarction or stroke. Results 7798 (43%) were treated with pPCI and 1798 (10%) underwent fibrinolysis; 8479 (47%) did not receive any reperfusion. The 2-year MACE was 9.6% following pPCI, 15.7% following fibrinolysis, and 21.5% for patients without reperfusion therapy (P<0.0001). Adjusted hazard ratios for 2-year MACE were 0.71 (95% confidence interval [CI] 0.65–0.78, P<0.0001) for pPCI versus no reperfusion and 0.92 (95% CI 0.82–1.03, P=0.16) for fibrinolysis versus no reperfusion. Compared with patients without reperfusion, fibrinolysis only showed benefit in patients presented within 3 hours of symptom onset (HR 0.70, 95% CI 0.57–0.85, P=0.0005), whereas pPCI was associated with significantly decreased 2-year MACE rate in patients presented within 3 hours (HR 0.53, 95% CI 0.44–0.64, P<0.0001), 3–6 hours (HR 0.60, 95% CI 0.51–0.71, P<0.0001) and >6 hours (HR 0.86, 95% CI 0.76–0.97, P=0.01) of symptom onset. Adjusted cumulative MACE rate Conclusions In a real-world setting, early reperfusion is the optimal strategy for STEMI. Fibrinolysis was not associated with better outcome in STEMI patients admitted >3 hours of symptom onset in Chinese real world setting. Acknowledgement/Funding Ministry of Science and Technology of China (Grant No. 2011BAI11B02)

Management of acute myocardial infarction in the real world: a summary report from The Ami-Florence Italian Registry

2008 ◽  
Vol 3 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Daniela Balzi ◽  
◽  
Alessandro Barchielli ◽  
Giovanni Maria Santoro ◽  
Nazario Carrabba ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Real World ◽  
Summary Report ◽  
The Real

scholarly journals Particulate Air Pollution and Risk of Cardiovascular Events Among Adults With a History of Stroke or Acute Myocardial Infarction

2021 ◽  
Author(s):  
Noelle S. Liao ◽  
Stephen Sidney ◽  
Kamala Deosaransingh ◽  
Stephen K. Van Den Eeden ◽  
Joel Schwartz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Mortality ◽  
State Regulation ◽  
Susceptible Population ◽  
Increased Risk ◽  
Address Data ◽  
History Of ◽  
Increase In Risk ◽  
Cvd Mortality

Background Previous studies have found associations between fine particulate matter <2.5 µm in diameter (PM 2.5 ) and increased risk of cardiovascular disease (CVD) among populations with no CVD history. Less is understood about susceptibility of adults with a history of CVD and subsequent PM 2.5 ‐related CVD events and whether current regulation levels for PM 2.5 are protective for this population. Methods and Results This retrospective cohort study included 96 582 Kaiser Permanente Northern California adults with a history of stroke or acute myocardial infarction. Outcome, covariate, and address data obtained from electronic health records were linked to time‐varying 1‐year mean PM 2.5 exposure estimates based on residential locations. Cox proportional hazard models estimated risks of stroke, acute myocardial infarction, and cardiovascular mortality associated with PM 2.5 exposure, adjusting for multiple covariates. Secondary analyses estimated risks below federal and state regulation levels (12 µg/m 3 for 1‐year mean PM 2.5 ). A 10‐µg/m 3 increase in 1‐year mean PM 2.5 exposure was associated with an increase in risk of cardiovascular mortality (hazard ratio [HR], 1.20; 95% CI, 1.11–1.30), but no increase in risk of stroke or acute myocardial infarction. Analyses of <12 µg/m 3 showed increased risk for CVD mortality (HR, 2.31; 95% CI, 1.96–2.71), stroke (HR, 1.41; 95% CI, 1.09–1.83]), and acute myocardial infarction (HR, 1.51; 95% CI, 1.21–1.89) per 10‐µg/m 3 increase in 1‐year mean PM 2.5 . Conclusions Adults with a history of CVD are susceptible to the effects of PM 2.5 exposure, particularly on CVD mortality. Increased risks observed at exposure levels <12 µg/m 3 highlight that current PM 2.5 regulation levels may not be protective for this susceptible population.

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