Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function
ObjectivesWe aimed to analyse outcomes of ticagrelor and clopidogrel stratified by estimated glomerular filtration rate (eGFR) in a large unselected cohort of patients with acute myocardial infarction (MI).MethodsWe used follow-up data in MI survivors discharged on ticagrelor or clopidogrel enrolled...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2018-10, Vol.104 (19), p.1575-1582 |
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| creator | Edfors, Robert Sahlén, Anders Szummer, Karolina Renlund, Henrik Evans, Marie Carrero, Juan-Jesus Spaak, Jonas James, Stefan K Lagerqvist, Bo Varenhorst, Christoph Jernberg, Tomas |
| description | ObjectivesWe aimed to analyse outcomes of ticagrelor and clopidogrel stratified by estimated glomerular filtration rate (eGFR) in a large unselected cohort of patients with acute myocardial infarction (MI).MethodsWe used follow-up data in MI survivors discharged on ticagrelor or clopidogrel enrolled in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry. The association between ticagrelor versus clopidogrel and the primary composite outcome of death, MI or stroke and the secondary outcome rehospitalisation with bleeding diagnosis at 1 year, was studied using adjusted Cox proportional hazards models, stratifying after eGFR levels.ResultsIn total, 45 206 patients with MI discharged on clopidogrel (n=33 472) or ticagrelor (n=11 734) were included. The unadjusted 1-year event rate for the composite endpoint of death, MI or stroke was 7.0%, 18.0% and 48.0% for ticagrelor treatment and 11.0%, 33.0% and 64.0% for clopidogrel treatment in patients with eGFR>60 (n=33 668), eGFR30–60 (n=9803) and eGFR60: HR 0.87, 95% CI 0.76 to 99, eGFR30–60: 0.82 (0.70 to 0.97), eGFR60: HR 1.10, 95% CI 0.90 to 1.35, eGFR30–60: 1.13 (0.84 to 1.51), eGFR |
| doi_str_mv | 10.1136/heartjnl-2017-312436 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_489554</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2115129990</sourcerecordid><originalsourceid>FETCH-LOGICAL-b450t-4480b2711ad95544f86a0daa063bd2e2f327dbf7ac9e060f8d378887c828ae8e3</originalsourceid><addsrcrecordid>eNqNkUtv1TAQRiMEoqXwDxCyxIYFoX7FdpZVoYBUqRtA7CzHmbS-JHHwg-pu-ttxyG0XSEisPJo5c2z5q6qXBL8jhInTGzAh7eaxppjImhHKmXhUHRMu1Nr6_rjUrGlqgZk8qp7FuMMY81aJp9URbRvJOWHH1d1VTtZPEJGb0WKSgzlFlAKYBD26dekGJWfNdYDRB_QLQswR2dEvrvdrE5khQUDG5gRo2ntrQu_MWGyDCTY5P6OYQvEOrvi6PQowl_GQ5z_D59WTwYwRXhzOk-rrxYcv55_qy6uPn8_PLuuONzjVnCvcUUmI6dum4XxQwuDeGCxY11OgA6Oy7wZpbAtY4EH1TCqlpFVUGVDATqp688ZbWHKnl-AmE_baG6cPrR-lAs3VekHh3_6Tf---nWkfrnXOmgnJyYq_2fAl-J8ZYtKTixbG0czgc9QlDyUEp1QW9PVf6M7nUP6kUIQ0hLZtiwvFN8oGH2OA4eEFBOs1fn0f_-qWeou_rL06yHM3Qf-wdJ93AU43oJt2_6f8Ddy_wAo</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2115129990</pqid></control><display><type>article</type><title>Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function</title><source>MEDLINE</source><source>PubMed Central</source><creator>Edfors, Robert ; Sahlén, Anders ; Szummer, Karolina ; Renlund, Henrik ; Evans, Marie ; Carrero, Juan-Jesus ; Spaak, Jonas ; James, Stefan K ; Lagerqvist, Bo ; Varenhorst, Christoph ; Jernberg, Tomas</creator><creatorcontrib>Edfors, Robert ; Sahlén, Anders ; Szummer, Karolina ; Renlund, Henrik ; Evans, Marie ; Carrero, Juan-Jesus ; Spaak, Jonas ; James, Stefan K ; Lagerqvist, Bo ; Varenhorst, Christoph ; Jernberg, Tomas</creatorcontrib><description>ObjectivesWe aimed to analyse outcomes of ticagrelor and clopidogrel stratified by estimated glomerular filtration rate (eGFR) in a large unselected cohort of patients with acute myocardial infarction (MI).MethodsWe used follow-up data in MI survivors discharged on ticagrelor or clopidogrel enrolled in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry. The association between ticagrelor versus clopidogrel and the primary composite outcome of death, MI or stroke and the secondary outcome rehospitalisation with bleeding diagnosis at 1 year, was studied using adjusted Cox proportional hazards models, stratifying after eGFR levels.ResultsIn total, 45 206 patients with MI discharged on clopidogrel (n=33 472) or ticagrelor (n=11 734) were included. The unadjusted 1-year event rate for the composite endpoint of death, MI or stroke was 7.0%, 18.0% and 48.0% for ticagrelor treatment and 11.0%, 33.0% and 64.0% for clopidogrel treatment in patients with eGFR>60 (n=33 668), eGFR30–60 (n=9803) and eGFR<30 (n=1735), respectively. After adjustment, ticagrelor as compared with clopidogrel was associated with a lower 1-year risk of the composite outcome (eGFR>60: HR 0.87, 95% CI 0.76 to 99, eGFR30–60: 0.82 (0.70 to 0.97), eGFR<30: 0.95 (0.69 to 1.29), P for interaction=0.55) and a higher risk of bleeding (eGFR>60: HR 1.10, 95% CI 0.90 to 1.35, eGFR30–60: 1.13 (0.84 to 1.51), eGFR<30: 1.79 (1.00 to 3.21), P for interaction=0.30) across the eGFR strata.ConclusionsTreatment with ticagrelor as compared with clopidogrel in patients with MI was associated with lower risk for the composite of death, MI or stroke and a higher bleeding risk across all strata of eGFR. Of caution, bleeding events were more abundant in patients with eGFR<30.</description><identifier>ISSN: 1355-6037</identifier><identifier>ISSN: 1468-201X</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2017-312436</identifier><identifier>PMID: 29574413</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Acute coronary syndromes ; acute myocardial infarction ; Aged ; Aspirin ; Blood platelets ; Cardiovascular disease ; Clopidogrel - administration & dosage ; Clopidogrel - adverse effects ; coronary artery disease ; Coronary vessels ; Diabetes ; epidemiology ; Female ; Glomerular Filtration Rate ; Heart attacks ; Hemorrhage - chemically induced ; Hemorrhage - epidemiology ; Hospitals ; Humans ; Kidney diseases ; Male ; Middle Aged ; Myocardial Infarction - diagnosis ; Myocardial Infarction - drug therapy ; Myocardial Infarction - mortality ; Outcome Assessment (Health Care) ; Patients ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Aggregation Inhibitors - adverse effects ; Registries - statistics & numerical data ; Risk Assessment - methods ; Stroke ; Stroke - epidemiology ; Stroke - etiology ; Sweden - epidemiology ; Ticagrelor - administration & dosage ; Ticagrelor - adverse effects</subject><ispartof>Heart (British Cardiac Society), 2018-10, Vol.104 (19), p.1575-1582</ispartof><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b450t-4480b2711ad95544f86a0daa063bd2e2f327dbf7ac9e060f8d378887c828ae8e3</citedby><cites>FETCH-LOGICAL-b450t-4480b2711ad95544f86a0daa063bd2e2f327dbf7ac9e060f8d378887c828ae8e3</cites><orcidid>0000-0003-2377-436X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29574413$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-367414$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:139271632$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Edfors, Robert</creatorcontrib><creatorcontrib>Sahlén, Anders</creatorcontrib><creatorcontrib>Szummer, Karolina</creatorcontrib><creatorcontrib>Renlund, Henrik</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Carrero, Juan-Jesus</creatorcontrib><creatorcontrib>Spaak, Jonas</creatorcontrib><creatorcontrib>James, Stefan K</creatorcontrib><creatorcontrib>Lagerqvist, Bo</creatorcontrib><creatorcontrib>Varenhorst, Christoph</creatorcontrib><creatorcontrib>Jernberg, Tomas</creatorcontrib><title>Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><description>ObjectivesWe aimed to analyse outcomes of ticagrelor and clopidogrel stratified by estimated glomerular filtration rate (eGFR) in a large unselected cohort of patients with acute myocardial infarction (MI).MethodsWe used follow-up data in MI survivors discharged on ticagrelor or clopidogrel enrolled in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry. The association between ticagrelor versus clopidogrel and the primary composite outcome of death, MI or stroke and the secondary outcome rehospitalisation with bleeding diagnosis at 1 year, was studied using adjusted Cox proportional hazards models, stratifying after eGFR levels.ResultsIn total, 45 206 patients with MI discharged on clopidogrel (n=33 472) or ticagrelor (n=11 734) were included. The unadjusted 1-year event rate for the composite endpoint of death, MI or stroke was 7.0%, 18.0% and 48.0% for ticagrelor treatment and 11.0%, 33.0% and 64.0% for clopidogrel treatment in patients with eGFR>60 (n=33 668), eGFR30–60 (n=9803) and eGFR<30 (n=1735), respectively. After adjustment, ticagrelor as compared with clopidogrel was associated with a lower 1-year risk of the composite outcome (eGFR>60: HR 0.87, 95% CI 0.76 to 99, eGFR30–60: 0.82 (0.70 to 0.97), eGFR<30: 0.95 (0.69 to 1.29), P for interaction=0.55) and a higher risk of bleeding (eGFR>60: HR 1.10, 95% CI 0.90 to 1.35, eGFR30–60: 1.13 (0.84 to 1.51), eGFR<30: 1.79 (1.00 to 3.21), P for interaction=0.30) across the eGFR strata.ConclusionsTreatment with ticagrelor as compared with clopidogrel in patients with MI was associated with lower risk for the composite of death, MI or stroke and a higher bleeding risk across all strata of eGFR. Of caution, bleeding events were more abundant in patients with eGFR<30.</description><subject>Acute coronary syndromes</subject><subject>acute myocardial infarction</subject><subject>Aged</subject><subject>Aspirin</subject><subject>Blood platelets</subject><subject>Cardiovascular disease</subject><subject>Clopidogrel - administration & dosage</subject><subject>Clopidogrel - adverse effects</subject><subject>coronary artery disease</subject><subject>Coronary vessels</subject><subject>Diabetes</subject><subject>epidemiology</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Heart attacks</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - epidemiology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - mortality</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patients</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Registries - statistics & numerical data</subject><subject>Risk Assessment - methods</subject><subject>Stroke</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Sweden - epidemiology</subject><subject>Ticagrelor - administration & dosage</subject><subject>Ticagrelor - adverse effects</subject><issn>1355-6037</issn><issn>1468-201X</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkUtv1TAQRiMEoqXwDxCyxIYFoX7FdpZVoYBUqRtA7CzHmbS-JHHwg-pu-ttxyG0XSEisPJo5c2z5q6qXBL8jhInTGzAh7eaxppjImhHKmXhUHRMu1Nr6_rjUrGlqgZk8qp7FuMMY81aJp9URbRvJOWHH1d1VTtZPEJGb0WKSgzlFlAKYBD26dekGJWfNdYDRB_QLQswR2dEvrvdrE5khQUDG5gRo2ntrQu_MWGyDCTY5P6OYQvEOrvi6PQowl_GQ5z_D59WTwYwRXhzOk-rrxYcv55_qy6uPn8_PLuuONzjVnCvcUUmI6dum4XxQwuDeGCxY11OgA6Oy7wZpbAtY4EH1TCqlpFVUGVDATqp688ZbWHKnl-AmE_baG6cPrR-lAs3VekHh3_6Tf---nWkfrnXOmgnJyYq_2fAl-J8ZYtKTixbG0czgc9QlDyUEp1QW9PVf6M7nUP6kUIQ0hLZtiwvFN8oGH2OA4eEFBOs1fn0f_-qWeou_rL06yHM3Qf-wdJ93AU43oJt2_6f8Ddy_wAo</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Edfors, Robert</creator><creator>Sahlén, Anders</creator><creator>Szummer, Karolina</creator><creator>Renlund, Henrik</creator><creator>Evans, Marie</creator><creator>Carrero, Juan-Jesus</creator><creator>Spaak, Jonas</creator><creator>James, Stefan K</creator><creator>Lagerqvist, Bo</creator><creator>Varenhorst, Christoph</creator><creator>Jernberg, Tomas</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DF2</scope><orcidid>https://orcid.org/0000-0003-2377-436X</orcidid></search><sort><creationdate>20181001</creationdate><title>Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function</title><author>Edfors, Robert ; Sahlén, Anders ; Szummer, Karolina ; Renlund, Henrik ; Evans, Marie ; Carrero, Juan-Jesus ; Spaak, Jonas ; James, Stefan K ; Lagerqvist, Bo ; Varenhorst, Christoph ; Jernberg, Tomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b450t-4480b2711ad95544f86a0daa063bd2e2f327dbf7ac9e060f8d378887c828ae8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute coronary syndromes</topic><topic>acute myocardial infarction</topic><topic>Aged</topic><topic>Aspirin</topic><topic>Blood platelets</topic><topic>Cardiovascular disease</topic><topic>Clopidogrel - administration & dosage</topic><topic>Clopidogrel - adverse effects</topic><topic>coronary artery disease</topic><topic>Coronary vessels</topic><topic>Diabetes</topic><topic>epidemiology</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Heart attacks</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - epidemiology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - mortality</topic><topic>Outcome Assessment (Health Care)</topic><topic>Patients</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Registries - statistics & numerical data</topic><topic>Risk Assessment - methods</topic><topic>Stroke</topic><topic>Stroke - epidemiology</topic><topic>Stroke - etiology</topic><topic>Sweden - epidemiology</topic><topic>Ticagrelor - administration & dosage</topic><topic>Ticagrelor - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Edfors, Robert</creatorcontrib><creatorcontrib>Sahlén, Anders</creatorcontrib><creatorcontrib>Szummer, Karolina</creatorcontrib><creatorcontrib>Renlund, Henrik</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Carrero, Juan-Jesus</creatorcontrib><creatorcontrib>Spaak, Jonas</creatorcontrib><creatorcontrib>James, Stefan K</creatorcontrib><creatorcontrib>Lagerqvist, Bo</creatorcontrib><creatorcontrib>Varenhorst, Christoph</creatorcontrib><creatorcontrib>Jernberg, Tomas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Uppsala universitet</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Edfors, Robert</au><au>Sahlén, Anders</au><au>Szummer, Karolina</au><au>Renlund, Henrik</au><au>Evans, Marie</au><au>Carrero, Juan-Jesus</au><au>Spaak, Jonas</au><au>James, Stefan K</au><au>Lagerqvist, Bo</au><au>Varenhorst, Christoph</au><au>Jernberg, Tomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function</atitle><jtitle>Heart (British Cardiac Society)</jtitle><addtitle>Heart</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>104</volume><issue>19</issue><spage>1575</spage><epage>1582</epage><pages>1575-1582</pages><issn>1355-6037</issn><issn>1468-201X</issn><eissn>1468-201X</eissn><abstract>ObjectivesWe aimed to analyse outcomes of ticagrelor and clopidogrel stratified by estimated glomerular filtration rate (eGFR) in a large unselected cohort of patients with acute myocardial infarction (MI).MethodsWe used follow-up data in MI survivors discharged on ticagrelor or clopidogrel enrolled in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry. The association between ticagrelor versus clopidogrel and the primary composite outcome of death, MI or stroke and the secondary outcome rehospitalisation with bleeding diagnosis at 1 year, was studied using adjusted Cox proportional hazards models, stratifying after eGFR levels.ResultsIn total, 45 206 patients with MI discharged on clopidogrel (n=33 472) or ticagrelor (n=11 734) were included. The unadjusted 1-year event rate for the composite endpoint of death, MI or stroke was 7.0%, 18.0% and 48.0% for ticagrelor treatment and 11.0%, 33.0% and 64.0% for clopidogrel treatment in patients with eGFR>60 (n=33 668), eGFR30–60 (n=9803) and eGFR<30 (n=1735), respectively. After adjustment, ticagrelor as compared with clopidogrel was associated with a lower 1-year risk of the composite outcome (eGFR>60: HR 0.87, 95% CI 0.76 to 99, eGFR30–60: 0.82 (0.70 to 0.97), eGFR<30: 0.95 (0.69 to 1.29), P for interaction=0.55) and a higher risk of bleeding (eGFR>60: HR 1.10, 95% CI 0.90 to 1.35, eGFR30–60: 1.13 (0.84 to 1.51), eGFR<30: 1.79 (1.00 to 3.21), P for interaction=0.30) across the eGFR strata.ConclusionsTreatment with ticagrelor as compared with clopidogrel in patients with MI was associated with lower risk for the composite of death, MI or stroke and a higher bleeding risk across all strata of eGFR. Of caution, bleeding events were more abundant in patients with eGFR<30.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>29574413</pmid><doi>10.1136/heartjnl-2017-312436</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-2377-436X</orcidid></addata></record> |
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| source | MEDLINE; PubMed Central |
| subjects | Acute coronary syndromes acute myocardial infarction Aged Aspirin Blood platelets Cardiovascular disease Clopidogrel - administration & dosage Clopidogrel - adverse effects coronary artery disease Coronary vessels Diabetes epidemiology Female Glomerular Filtration Rate Heart attacks Hemorrhage - chemically induced Hemorrhage - epidemiology Hospitals Humans Kidney diseases Male Middle Aged Myocardial Infarction - diagnosis Myocardial Infarction - drug therapy Myocardial Infarction - mortality Outcome Assessment (Health Care) Patients Platelet Aggregation Inhibitors - administration & dosage Platelet Aggregation Inhibitors - adverse effects Registries - statistics & numerical data Risk Assessment - methods Stroke Stroke - epidemiology Stroke - etiology Sweden - epidemiology Ticagrelor - administration & dosage Ticagrelor - adverse effects |
| title | Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function |
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