Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

Research output: Contribution to journalJournal articleResearchpeer-review

Harvard

APA

CBE

MLA

Vancouver

Author

Bibtex

@article{fbf9eaf202bf40b3954ca1508911e025,
title = "Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups",
abstract = "BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization.METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population.RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7{\%} males). Use of dual anti-platelet treatment decreased with age: 80{\%} (<60 years), 76{\%} (60-69 years), 66{\%} (70-79 years) and 52{\%} (>79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users <60 years (Hazard ratio (HR) =0.69; 95{\%} confidence interval (CI) 0.59-0.80), 60-69 years (HR=0.64; 95{\%} CI 0.56-0.73), 70-79 years (HR=0.80; 95{\%} CI 0.72-0.89) and >79 years (HR=0.92; 95{\%} CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged <60 years (HR=1.63; 95{\%} CI 1.17-2.26), 60-69 years (HR=1.22; 95{\%} CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95{\%} CI 1.17-1.72) and >79 years (HR=1.46; 95{\%} CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population.CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.",
keywords = "Journal Article",
author = "Nikolai Juul and Gunnar Gislason and Olesen, {Jonas Bjerring} and Morten Lamberts and Hansen, {Morten Lock} and Deniz Karasoy and Christiansen, {Christine Benn} and Christian Torp-Pedersen and Rikke Sorensen",
year = "2017",
month = "9",
doi = "10.1177/2048872614538848",
language = "English",
volume = "6",
pages = "511--521",
journal = "European Heart Journal: Acute Cardiovascular Care",
issn = "2048-8726",
publisher = "SAGE Publications Ltd",
number = "6",

}

RIS

TY - JOUR

T1 - Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

AU - Juul, Nikolai

AU - Gislason, Gunnar

AU - Olesen, Jonas Bjerring

AU - Lamberts, Morten

AU - Hansen, Morten Lock

AU - Karasoy, Deniz

AU - Christiansen, Christine Benn

AU - Torp-Pedersen, Christian

AU - Sorensen, Rikke

PY - 2017/9

Y1 - 2017/9

N2 - BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization.METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population.RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (<60 years), 76% (60-69 years), 66% (70-79 years) and 52% (>79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users <60 years (Hazard ratio (HR) =0.69; 95% confidence interval (CI) 0.59-0.80), 60-69 years (HR=0.64; 95% CI 0.56-0.73), 70-79 years (HR=0.80; 95% CI 0.72-0.89) and >79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged <60 years (HR=1.63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population.CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

AB - BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization.METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population.RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (<60 years), 76% (60-69 years), 66% (70-79 years) and 52% (>79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users <60 years (Hazard ratio (HR) =0.69; 95% confidence interval (CI) 0.59-0.80), 60-69 years (HR=0.64; 95% CI 0.56-0.73), 70-79 years (HR=0.80; 95% CI 0.72-0.89) and >79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged <60 years (HR=1.63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population.CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

KW - Journal Article

U2 - 10.1177/2048872614538848

DO - 10.1177/2048872614538848

M3 - Journal article

VL - 6

SP - 511

EP - 521

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

SN - 2048-8726

IS - 6

ER -

ID: 52554057