1
|
Mozaffarian S, Etemad K, Aghaali M, Khodakarim S, Sotoodeh Ghorbani S, Hashemi Nazari SS. Short and Long-Term Survival Rates Following Myocardial Infarction and Its Predictive Factors: A Study Using National Registry Data. J Tehran Heart Cent 2022; 16:68-74. [PMID: 35082874 PMCID: PMC8742861 DOI: 10.18502/jthc.v16i2.7387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Coronary artery disease is the most common cause of death worldwide as well as in Iran. The present study was designed to predict short and long-term survival rates after the first episode of myocardial infarction (MI). Methods: The current research is a retrospective cohort study. The data were collected from the Myocardial Infarction Registry of Iran in a 12-month period leading to March 20, 2014. The variables analyzed included smoking status, past medical history of chronic heart disease, hypertension, diabetes, hyperlipidemia, signs and symptoms during an attack, post-MI complications during hospitalization, the occurrence of arrhythmias, the location of MI, and the place of residence. Survival rates and predictive factors were estimated by the Kaplan–Meier method, the log-rank test, and the Cox model. Results: Totally, 21 181 patients with the first MI were studied. There were 15 328 men (72.4%), and the mean age of the study population was 62.10±13.42 years. During a 1-year period following MI, 2479 patients (11.7%) died. Overall, the survival rates at 28 days, 6 months, and 1 year were estimated to be 0.95 (95% CI: 0.95 to 0.96), 0.90 (95% CI: 0.90 to 0.91), and 0.88 (95% CI: 0.88 to 0.89). After the confounding factors were controlled, history of chronic heart disease (p<0.001), hypertension (p<0.001), and diabetes (p<0.001) had a significant relationship with an increased risk of death and history of hyperlipidemia (p<0.001) and inferior wall MI (p<0.001) had a significant relationship with a decreased risk of death. Conclusion: The results of this study provide evidence for health policy-makers and physicians on the link between MI and its predictive factors.
Collapse
Affiliation(s)
- Samaneh Mozaffarian
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Korosh Etemad
- Environmental and Occupational Hazard Control Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Aghaali
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Sotoodeh Ghorbani
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Dai K, Li Z, Luo Y, Xiong Q, Xiong Y, Song Z, Xiong W. The Predictive Value of the Monocyte-to-Lymphocyte Ratio and Monocyte-to-Haematocrit Ratio for Cardiac Rupture Patients with Acute Myocardial Infarction: A Propensity Score Matching Analysis. Healthc Policy 2022; 15:37-44. [PMID: 35079225 PMCID: PMC8776727 DOI: 10.2147/rmhp.s348894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cardiac rupture (CR) is a serious complication of acute myocardial infarction (AMI). We aimed to explore the predictive value of blood cell parameters for identifying CR in patients with AMI using the introduction of propensity score matching (PSM). Methods This retrospective study enrolled patients who were diagnosed with AMI from January 2013 to May 2020. A total of 109 patients with CR were included, and 327 hospitalized non-CR patients were randomly selected at a 1:3 ratio. Based on the 1:1 nearest neighbour matching method by using SPSS, the covariances of the two groups were balanced. After PSM, the independent risk factors for CR were selected by using multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve analysis was applied to evaluate the predictive value of blood cell parameters for CR. Ninety cases were matched successfully in each of the two groups. Results Among the 180 patients with AMI after PSM, the results of multivariate logistic regression analysis showed that the monocyte-to-lymphocyte ratio (MLR) (OR = 3.57, 95% CI: 1.28–9.97, P = 0.015) and monocyte-to-haematocrit ratio (MHR) (OR = 1.80, 95% CI: 1.02–3.20, P = 0.043) were independently related to the risk of CR. Additionally, the MLR (area under the curve (AUC): 0.74) and MHR (AUC: 0.73) were useful for distinguishing CR patients after PSM. To differentiate CR patients from the control subjects, the optimal cut-offs of the MLR and MHR were 0.61 (63% sensitivity and 80% specificity) and 2.06 (57% sensitivity and 81% specificity), respectively. Conclusion The blood cell parameters MLR and MHR were independently correlated with CR. Additional, the MLR and MHR were useful to predict CR in patients with AMI.
Collapse
Affiliation(s)
- Kai Dai
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Zhibing Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Yafei Luo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Qianhui Xiong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Yao Xiong
- Department of Cardiovascular Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Zhifang Song
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Wenjun Xiong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
- Correspondence: Wenjun Xiong, Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, No. 461 Bayi Avenue, Nanchang, 330006, Jiangxi, People’s Republic of China, Tel +8613767970074, Email
| |
Collapse
|
3
|
Chichareon P, van Klaveren D, Modolo R, Kogame N, Takahashi K, Chang CC, Tomaniak M, Yuan J, Xie L, Song Y, Qiao S, Yang Y, Guan C, Zurakowski A, van Geuns RJ, Sabate M, Ong PJ, Wykrzykowska JJ, Piek JJ, Garg S, Hamm C, Steg G, Vranckx P, Valgimigli M, Windecker S, Juni P, Onuma Y, Steyerberg E, Xu B, Serruys PW. Predicting 2-year all-cause mortality after contemporary PCI: Updating the logistic clinical SYNTAX score. Catheter Cardiovasc Interv 2021; 98:1287-1297. [PMID: 33539048 DOI: 10.1002/ccd.29490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/02/2020] [Accepted: 12/27/2020] [Indexed: 01/04/2023]
Abstract
AIMS We aimed to update the logistic clinical SYNTAX score to predict 2 year all-cause mortality after contemporary percutaneous coronary intervention (PCI). METHODS AND RESULTS We analyzed 15,883 patients in the GLOBAL LEADERS study who underwent PCI. The logistic clinical SYNTAX model was updated after imputing missing values by refitting the original model (refitted original model) and fitting an extended new model (new model, with, selection based on the Akaike Information Criterion). External validation was performed in 10,100 patients having PCI at Fu Wai hospital. Chronic obstructive pulmonary disease, prior stroke, current smoker, hemoglobin level, and white blood cell count were identified as additional independent predictors of 2 year all-cause mortality and included into the new model. The c-indexes of the original, refitted original and the new model in the derivation cohort were 0.74 (95% CI 0.72-0.76), 0.75 (95% CI 0.73-0.77), and 0.78 (95% CI 0.76-0.80), respectively. The c-index of the new model was lower in the validation cohort than in the derivation cohort, but still showed improved discriminative ability of the newly developed model (0.72; 95% CI 0.67-0.77) compared to the refitted original model (0.69; 95% CI 0.64-0.74). The models overestimated the observed 2 year all-cause mortality of 1.11% in the Chinese external validation cohort by 0.54 percentage points, indicating the need for calibration of the model to the Chinese patient population. CONCLUSIONS The new model of the logistic clinical SYNTAX score better predicts 2 year all-cause mortality after PCI than the original model. The new model could guide clinical decision making by risk stratifying patients undergoing PCI.
Collapse
Affiliation(s)
- Ply Chichareon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Rodrigo Modolo
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Norihiro Kogame
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kuniaki Takahashi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chun-Chin Chang
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mariusz Tomaniak
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Lihua Xie
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Ying Song
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Shubin Qiao
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Yuejin Yang
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Changdong Guan
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Aleksander Zurakowski
- American Heart of Poland, Center for Cardiovascular Research and Development, Katowice, Poland
| | - Robert-Jan van Geuns
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manel Sabate
- University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paul J Ong
- Tan Tock Seng Hospital, Novena, Singapore
| | - Joanna J Wykrzykowska
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christian Hamm
- Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany
| | - Gabriel Steg
- FACT, French Alliance for Cardiovascular Trials; Hôpital Bichat, AP-HP, Université Paris-Diderot; and INSERM U-1148, all in Paris, Paris, France.,Royal Brompton Hospital, Imperial College, London, UK
| | - Pascal Vranckx
- Hartcentrum Hasselt, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Peter Juni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Ewout Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.,NHLI, Imperial College London, London, UK
| |
Collapse
|
4
|
Fraticelli L, Kleitz O, Claustre C, Eydoux N, Peiretti A, Tazarourte K, Bonnefoy-Cudraz E, Dussart C, El Khoury C. Comparison of the pathways of care and life courses between first-time ST-elevation myocardial infarction (STEMI) and STEMI with prior MI: findings from the OSCAR registry. BMJ Open 2020; 10:e038773. [PMID: 33154054 PMCID: PMC7646338 DOI: 10.1136/bmjopen-2020-038773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We hypothesised that patients having experienced one coronary event in their life were susceptible to present differences in their pathways of care and within 1 year of their life courses. We aimed to compare pathways between first-time ST-elevation myocardial infarction (STEMI) and STEMI with prior myocardial infarction (MI). DESIGN A retrospective observational study based on the Observatoire des Syndromes Coronariens Aigus du réseau RESCUe (OSCAR) registry collecting all suspected STEMI from 10 percutaneous coronary intervention centres in France. SETTING All patients with STEMI from 2013 to 2017 were included (N=6306 with 5423 first-time STEMI and 883 STEMI with prior MI). We provided a matching analysis by propensity score based on cardiovascular risk factors. PARTICIPANTS We defined first-time STEMI as STEMI occurring at the inclusion date, and STEMI with prior MI as STEMI with a history of MI prior to the inclusion date. RESULTS Patients with first-time STEMI and patients with STEMI with prior MI were equally treated during hospitalisation and at discharge. At 12 months, patients with first-time STEMI had a lower adherence to BASIC treatment (ie, beta-blocker, antiplatelet therapy, statin and converting enzyme inhibitor) (48.11% vs 58.58%, p=0.0167), more frequently completed the cardiac rehabilitation programme (44.33% vs 31.72%, p=0.0029), more frequently changed their lifestyle behaviours; more frequently practiced daily physical activity (48.11% vs 35.82%, p=0.0043) and more frequently stopped smoking at admission (69.39% vs 55.00%, p=0.0524). The estimated mortality was higher for patients with STEMI with prior MI at 1 month (p=0.0100), 6 months (p=0.0500) and 1 year (p=0.0600). CONCLUSIONS We provided an exhaustive overview of the real-life clinical practice conditions of STEMI management. The patients with STEMI with prior MI presented an optimised use of prehospital resources, which was probably due to their previous experience, and showed a better adherence to drug therapy compared with patients with first-time STEMI. TRIAL REGISTRATION NUMBER Commission Nationale de l'Informatique et des Libertés (number 2 013 090 v0).
Collapse
Affiliation(s)
- Laurie Fraticelli
- RESCUe-RESUVal network, Hospital Center Lucien Hussel, Vienne, France
- Laboratory Systemic Health Care, EA 4129, University of Lyon 1, Lyon, France
| | - Olivier Kleitz
- RESCUe-RESUVal network, Hospital Center Lucien Hussel, Vienne, France
| | - Clément Claustre
- RESCUe-RESUVal network, Hospital Center Lucien Hussel, Vienne, France
| | - Nicolas Eydoux
- RESCUe-RESUVal network, Hospital Center Lucien Hussel, Vienne, France
| | | | - Karim Tazarourte
- Department of Emergency Medicine and SAMU, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- HESPER EA 7425, Claude Bernard Lyon 1 University, Lyon, France
| | - Eric Bonnefoy-Cudraz
- Cardiology intensive care unit, Hospital Louis Pradel, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Claude Dussart
- Laboratory Systemic Health Care, EA 4129, University of Lyon 1, Lyon, France
| | - Carlos El Khoury
- HESPER EA 7425, Claude Bernard Lyon 1 University, Lyon, France
- Clinical Research Unit and Emergency Department, Médipôle Lyon-Villeurbanne, Villeurbanne, France
| |
Collapse
|
5
|
Reda A, Almahmeed W, Dobrecky-Mery I, Huang PH, Juarez-Herrera U, Ranjith N, Sayre T, Urina-Triana M. A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America. Adv Ther 2020; 37:1754-1777. [PMID: 32227306 PMCID: PMC7467479 DOI: 10.1007/s12325-020-01302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 11/28/2022]
Abstract
Patients who have experienced an acute coronary syndrome (ACS) are at very high risk of recurrent atherosclerotic cardiovascular disease (CVD) events. Dyslipidaemia, a major risk factor for CVD, is poorly controlled post ACS in countries outside Western Europe and North America, despite the availability of effective lipid-modifying therapies (LMTs) and guidelines governing their use. Recent guideline updates recommend that low-density lipoprotein cholesterol (LDL-C), the primary target for dyslipidaemia therapy, be reduced by ≥ 50% and to < 1.4 mmol/L (55 mg/dL) in patients at very high risk of CVD, including those with ACS. The high prevalence of CVD risk factors in some regions outside Western Europe and North America confers a higher risk of CVD on patients in these countries. ACS onset is often earlier in these patients, and they may be more challenging to treat. Other barriers to effective dyslipidaemia control include low awareness of the value of intensive lipid lowering in patients with ACS, physician non-adherence to guideline recommendations, and lack of efficacy of currently used LMTs. Lack of appropriate pathways to guide follow-up of patients with ACS post discharge and poor access to intensive medications are important factors limiting dyslipidaemia therapy in many countries. Opportunities exist to improve attainment of LDL-C targets by the use of country-specific treatment algorithms to promote adherence to guideline recommendations, medical education and greater prioritisation by healthcare systems of dyslipidaemia management in very high risk patients. Video Abstract
Collapse
Affiliation(s)
- Ashraf Reda
- Department of Cardiology, Menoufia University, 127 Mohamed Fareed Street, Babellouk, Cairo, Egypt.
| | - Wael Almahmeed
- Department of Cardiovascular Medicine, Cleveland Clinic, Abu Dhabi, UAE
| | | | - Po-Hsun Huang
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | - Miguel Urina-Triana
- Cardiology Division, Faculty of Health Sciences, Simón Bolívar University, Barranquilla, Colombia
| |
Collapse
|
6
|
Mal K, Awan ID, Shaukat F. Evaluation of Risk Factors Associated with Reinfarction: A Multicenter Observational Study. Cureus 2019; 11:e6063. [PMID: 31827993 PMCID: PMC6890158 DOI: 10.7759/cureus.6063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Reinfarction after incidence of myocardial infarction is a serious complication and is responsible for high mortality. Various factors are responsible for reinfarction including smoking, prior procedures or surgeries, and use of medications such as aspirin, β-blocker, and angiotensin-converting enzyme Iihibitor or angiotensin receptor blockers. Material and Methods: This prospective study was conducted with 243 participants. Participants were divided into two groups: patients who had a reinfarction during hospital and patients who did not. Results: There were 142 (58.4%) men and 101 (41.6%) women in the study. A total of 17 (6.9%) patients had reinfarction. Age (68.4±10.9 vs. 64.4±11.8; 0.001), diabetes (47.05% vs. 22.12%; 0.02), and history of myocardial infarction (29.5% vs. 11.4%; 0.02) were identified as risk factors for reinfarction Conclusion: Our study reports that certain parameters such as age, obesity, diabetes mellitus,, and history of myocardial infarction can be used to assess the risk of reinfarction among these patients.
Collapse
Affiliation(s)
- Kheraj Mal
- Cardiology, National Institute of Cardiovascular System, Sukkur, PAK
| | | | - Faizan Shaukat
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| |
Collapse
|
7
|
Combination Therapy with Dipyridamole and Clopidogrel for Secondary Stroke Prevention in Aspirin-Intolerant Patients After Myocardial Infarction: Results of a Nationwide Case-Control Study. CNS Drugs 2019; 33:175-185. [PMID: 30649687 PMCID: PMC6373395 DOI: 10.1007/s40263-018-0591-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Combination therapy with dipyridamole and clopidogrel in stroke prevention and long-term outcomes in aspirin-intolerant patients with acute myocardial infarction (AMI) and previous stroke are unknown. This nationwide study analyzed the impact of dipyridamole and clopidogrel on secondary stroke prevention and long-term outcomes in aspirin-intolerant stroke patients after AMI. METHODS This was a nationwide, case-control study involving 186,112 first AMI patients, 78,607 of whom had a previous history of stroke. In the final analysis, we included 4637 patients taking clopidogrel alone and 208 patients using a combination of clopidogrel and dipyridamole. RESULTS The 12-year survival rate was not different between clopidogrel and clopidogrel-dipyridamole groups (log-rank p = 0.6247). Furthermore, there were no differences in event-free survival after stroke (log-rank p = 0.6842), gastrointestinal (GI) bleeding (log-rank p = 0.9539), or intracerebral hemorrhage (ICH; log-rank p = 0.6191) between the two groups. Dipyridamole did not contribute significantly to AMI survival (hazard ratio 0.98, 95% confidence interval 0.84-1.15), and did not show benefits in any of the subgroups regardless of sex, age (younger or older than 75 years), comorbidities, percutaneous coronary intervention, or medications. CONCLUSION No differences were observed in the 12-year survival rate between clopidogrel and clopidogrel-dipyridamole groups. The two groups had balanced event-free survival in recurrent stroke, ICH, GI bleeding, and myocardial infarction.
Collapse
|