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Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature150959
Source
Europace. 2009 Jul;11(7):886-91
Publication Type
Article
Date
Jul-2009
Author
Søren Skøtt Andersen
Morten Lock Hansen
Gunnar H Gislason
Tina Ken Schramm
Fredrik Folke
Emil Fosbøl
Steen Z Abildstrøm
Mette Madsen
Lars Køber
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup, Copenhagen DK-2900, Denmark. ssa@heart.dk
Source
Europace. 2009 Jul;11(7):886-91
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Cohort Studies
Denmark - epidemiology
Female
Humans
Incidence
Male
Middle Aged
Proportional Hazards Models
Registries
Risk assessment
Risk factors
Survival Analysis
Survival Rate
Treatment Outcome
Abstract
To examine the risk of death associated with antiarrhythmic drug (AAD) therapy in a nationwide unselected cohort of patients with atrial fibrillation (AF).
All patients admitted with AF in Denmark from 1995 to 2004 and their subsequent use of AADs were identified by individual-level linkage of nationwide registries. Multivariable Cox proportional-hazard models with time-dependent covariates were used to analyse the risk of death associated with AAD therapy. A total of 141,500 patients were included in the study; of these 3356 (2.4%) patients received treatment with flecainide, 3745 (2.6%) propafenone, 23,346 (16.5%) sotalol, and 10,376 (7.3%) amiodarone. Annualized mortality rates were 2.54, 4.25, 5.29, and 7.42 per year per 100 person years for flecainide, propafenone, sotalol, and amiodarone, respectively. Multivariable Cox proportional-hazard models did not show increased risk of death associated with any of the AADs. Hazard ratio (95% confidence interval) for flecainide 0.38 (0.32-0.44), propafenone 0.65 (0.58-0.71), sotalol 0.65 (0.63-0.67), and amiodarone 0.94 (0.89-1.00).
In an unselected cohort of patients with AF, antiarrhythmic treatment with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death. From a safety perspective, this indicates appropriate selection of patients for AAD therapy.
Notes
Comment In: Europace. 2009 Jul;11(7):840-119546183
Comment In: Europace. 2009 Jul;11(7):837-919546182
PubMed ID
19443433 View in PubMed
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Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature106936
Source
JAMA. 2013 Oct 2;310(13):1377-84
Publication Type
Article
Date
Oct-2-2013
Author
Mads Wissenberg
Freddy K Lippert
Fredrik Folke
Peter Weeke
Carolina Malta Hansen
Erika Frischknecht Christensen
Henning Jans
Poul Anders Hansen
Torsten Lang-Jensen
Jonas Bjerring Olesen
Jesper Lindhardsen
Emil L Fosbol
Søren L Nielsen
Gunnar H Gislason
Lars Kober
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. mads.wissenberg.joergensen@regionh.dk
Source
JAMA. 2013 Oct 2;310(13):1377-84
Date
Oct-2-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation
Causality
Denmark - epidemiology
Female
Government Programs
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - mortality - therapy
Registries - statistics & numerical data
Survival Analysis
Time Factors
Abstract
Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival.
To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care.
Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29,111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n?=?7390) and those with cardiac arrests witnessed by emergency medical services personnel (n?=?2253), leaving a study population of 19,468 patients.
Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival.
The median age of patients was 72 years; 67.4% were men. Bystander CPR increased significantly during the study period, from 21.1% (95% CI, 18.8%-23.4%) in 2001 to 44.9% (95% CI, 42.6%-47.1%) in 2010 (P?
PubMed ID
24084923 View in PubMed
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Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends.

https://arctichealth.org/en/permalink/ahliterature107254
Source
Circulation. 2013 Nov 12;128(20):2224-31
Publication Type
Article
Date
Nov-12-2013
Author
Carolina Malta Hansen
Mads Wissenberg
Peter Weeke
Martin Huth Ruwald
Morten Lamberts
Freddy Knudsen Lippert
Gunnar Hilmar Gislason
Søren Loumann Nielsen
Lars Køber
Christian Torp-Pedersen
Fredrik Folke
Author Affiliation
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup (C.M.H., M.W., P.W., M.H.R., M.L., G.H.G., F.F.); Emergency Medical Services, Copenhagen, Capital Region of Denmark and Copenhagen University (F.K.L., S.L.N.); National Institute of Public Health, University of Southern Denmark, Copenhagen (G.H.G.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen (L.K.); and Institute of Health, Science and Technology, Aalborg University, Aalborg (C.T.-P.), Denmark.
Source
Circulation. 2013 Nov 12;128(20):2224-31
Date
Nov-12-2013
Language
English
Publication Type
Article
Keywords
Adult
After-Hours Care - statistics & numerical data
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation - mortality
Cities - statistics & numerical data
Defibrillators - statistics & numerical data
Denmark - epidemiology
Female
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - mortality - therapy
Residence Characteristics
Abstract
Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations.
We identified cardiac arrests in public locations (1994-2011) in terms of location and time and viewed them in relation to the location and accessibility of all AEDs linked to the emergency dispatch center as of December 31, 2011, in Copenhagen, Denmark. AED coverage of cardiac arrests was defined as cardiac arrests within 100 m (109.4 yd) of an AED and further categorized according to AED accessibility at the time of cardiac arrest. Daytime, evening, and nighttime were defined as 8 am to 3:59 pm, 4 to 11:59 pm, and midnight to 7:59 am, respectively. Of 1864 cardiac arrests in public locations, 61.8% (n=1152) occurred during the evening, nighttime, or weekends. Of 552 registered AEDs, 9.1% (n=50) were accessible at all hours, and 96.4% (n=532) were accessible during the daytime on all weekdays. Regardless of AED accessibility, 28.8% (537 of 1864) of all cardiac arrests were covered by an AED. Limited AED accessibility decreased coverage of cardiac arrests by 4.1% (9 of 217) during the daytime on weekdays and by 53.4% (171 of 320) during the evening, nighttime, and weekends.
Limited AED accessibility at the time of cardiac arrest decreased AED coverage by 53.4% during the evening, nighttime, and weekends, which is when 61.8% of all cardiac arrests in public locations occurred. Thus, not only strategic placement but also uninterrupted AED accessibility warrant attention if public-access defibrillation is to improve survival after out-of-hospital cardiac arrest.
PubMed ID
24036607 View in PubMed
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Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest.

https://arctichealth.org/en/permalink/ahliterature282560
Source
N Engl J Med. 2017 05 04;376(18):1737-1747
Publication Type
Article
Date
05-04-2017
Author
Kristian Kragholm
Mads Wissenberg
Rikke N Mortensen
Steen M Hansen
Carolina Malta Hansen
Kristinn Thorsteinsson
Shahzleen Rajan
Freddy Lippert
Fredrik Folke
Gunnar Gislason
Lars Køber
Kirsten Fonager
Svend E Jensen
Thomas A Gerds
Christian Torp-Pedersen
Bodil S Rasmussen
Source
N Engl J Med. 2017 05 04;376(18):1737-1747
Date
05-04-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiopulmonary Resuscitation
Denmark
Electric Countershock
Female
Humans
Hypoxia, Brain - epidemiology - etiology
Institutionalization - statistics & numerical data
Intention to Treat Analysis
Male
Middle Aged
Nursing Homes
Out-of-Hospital Cardiac Arrest - complications - mortality - therapy
Risk
Survival Analysis
Volunteers
Abstract
The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied.
We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes.
Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P
PubMed ID
28467879 View in PubMed
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Cause-specific cardiovascular risk associated with nonsteroidal antiinflammatory drugs among healthy individuals.

https://arctichealth.org/en/permalink/ahliterature143012
Source
Circ Cardiovasc Qual Outcomes. 2010 Jul;3(4):395-405
Publication Type
Article
Date
Jul-2010
Author
Emil Loldrup Fosbøl
Fredrik Folke
Søren Jacobsen
Jeppe N Rasmussen
Rikke Sørensen
Tina Ken Schramm
Søren S Andersen
Søren Rasmussen
Henrik Enghusen Poulsen
Lars Køber
Christian Torp-Pedersen
Gunnar H Gislason
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. ELF@heart.dk
Source
Circ Cardiovasc Qual Outcomes. 2010 Jul;3(4):395-405
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adult
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
Cardiovascular Diseases - epidemiology - etiology - mortality - physiopathology
Cause of Death
Cross-Over Studies
Denmark
Female
Humans
Male
Middle Aged
Risk factors
Substance-Related Disorders - epidemiology - etiology - mortality - physiopathology
Survival Analysis
Abstract
Studies have raised concern on the cardiovascular safety of nonsteroidal antiinflammatory drugs (NSAIDs). We studied safety of NSAID therapy in a nationwide cohort of healthy individuals.
With the use of individual-level linkage of nationwide administrative registers, we identified a cohort of individuals without hospitalizations 5 years before first prescription claim of NSAIDs and without claimed drug prescriptions for selected concomitant medication 2 years previously. The risk of cardiovascular death, a composite of coronary death or nonfatal myocardial infarction, and fatal or nonfatal stroke associated with the use of NSAIDs was estimated by case-crossover and Cox proportional hazard analyses. The entire Danish population age 10 years or more consisted of 4,614,807 individuals on January 1, 1997, of which 2,663,706 (57.8%) claimed at least 1 prescription for NSAIDs during 1997 to 2005. Of these; 1,028,437 individuals were included in the study after applying selection criteria regarding comorbidity and concomitant pharmacotherapy. Use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with an increased risk of cardiovascular death (odds ratio, 1.91; 95% confidence interval, 1.62 to 2.42; and odds ratio, 1.66; 95% confidence interval, 1.06 to 2.59, respectively), with a dose-dependent increase in risk. There was a trend for increased risk of fatal or nonfatal stroke associated with ibuprofen treatment (odds ratio, 1.29; 95% confidence interval, 1.02 to 1.63), but naproxen was not associated with increased cardiovascular risk (odds ratio for cardiovascular death, 0.84; 95% confidence interval, 0.50 to 1.42).
Individual NSAIDs have different degrees of cardiovascular safety, which must be considered when choosing appropriate treatment. In particular, rofecoxib and diclofenac were associated with increased cardiovascular mortality and morbidity and should be used with caution in most individuals, whereas our results suggest that naproxen has a safer cardiovascular risk-profile.
PubMed ID
20530789 View in PubMed
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Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study.

https://arctichealth.org/en/permalink/ahliterature116575
Source
PLoS One. 2013;8(1):e54309
Publication Type
Article
Date
2013
Author
Anne-Marie Schjerning Olsen
Emil L Fosbøl
Jesper Lindhardsen
Charlotte Andersson
Fredrik Folke
Mia B Nielsen
Lars Køber
Peter R Hansen
Christian Torp-Pedersen
Gunnar H Gislason
Author Affiliation
Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark. amschjerning@gmail.com
Source
PLoS One. 2013;8(1):e54309
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage - adverse effects
Denmark
Diclofenac - administration & dosage - adverse effects
Female
Follow-Up Studies
Hospitalization
Humans
Lactones - administration & dosage - adverse effects
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality - pathology
Proportional Hazards Models
Registries
Risk factors
Sulfones - administration & dosage - adverse effects
Abstract
Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients.
By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49). In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively) with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44]), whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59].
Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI.
Notes
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PubMed ID
23382889 View in PubMed
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Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation.

https://arctichealth.org/en/permalink/ahliterature141913
Source
Circulation. 2010 Aug 10;122(6):623-30
Publication Type
Article
Date
Aug-10-2010
Author
Fredrik Folke
Gunnar H Gislason
Freddy K Lippert
Søren L Nielsen
Peter Weeke
Morten L Hansen
Emil L Fosbøl
Søren S Andersen
Søren Rasmussen
Tina K Schramm
Lars Køber
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. FF@heart.dk
Source
Circulation. 2010 Aug 10;122(6):623-30
Date
Aug-10-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation - instrumentation - utilization
Defibrillators - utilization
Denmark - epidemiology
Emergency Medical Services - manpower - trends
Female
Heart Arrest - epidemiology - therapy
Hospitalization
Humans
Male
Middle Aged
Mobile Health Units - manpower - trends
Population Surveillance
Public Facilities
Risk factors
Abstract
The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations.
We studied 4828 OHCAs in Copenhagen between 1994 and 2005. The incidence and characteristics of OHCA were examined in every 100 x 100-m (109.4 x 109.4-yd) residential area according to its underlying demographic characteristics. By combining > or =2 demographic characteristics, it was possible to identify 100 x 100-m (109.4 x 109.4-yd) areas with at least 1 arrest every 5.6 years (characterized by >300 persons per area and lowest income) to 1 arrest every 4.3 years (characterized by >300 persons per area, lowest income, low education, and highest age). These areas covered 9.0% and 0.8% of all residential OHCAs, respectively. Individuals with OHCA in residential locations differed from public ones in that the patients were older (70.6 versus 60.6 years; P
Notes
Comment In: Circulation. 2010 Aug 10;122(6):567-920660801
PubMed ID
20660807 View in PubMed
Less detail

[Disagreement between physicians' medication records and information given by patients]

https://arctichealth.org/en/permalink/ahliterature70408
Source
Ugeskr Laeger. 2006 Mar 27;168(13):1307-10
Publication Type
Article
Date
Mar-27-2006
Author
Rasmus Rabøl
Gry Rosenkjaer Arrøe
Fredrik Folke
Kristian Rørbaek Madsen
Michael Thøger Langergaard
Annette Højmann Larsen
Tommy Budek
Jens Rikardt Andersen
Author Affiliation
Nykøbing Falster Centralsygehus, Medicinsk Afdeling, Faglig Udvikling i Almen Praksis (FUAP), Storstrøms Amt og Den Kgl. Veterinaer- og Landbohøjskole, Institut for Human Ernaering. rraboel@dadlnet.dk
Source
Ugeskr Laeger. 2006 Mar 27;168(13):1307-10
Date
Mar-27-2006
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Comparative Study
Denmark
English Abstract
Family Practice
Female
Humans
Interdisciplinary Communication
Interviews
Male
Medical Record Linkage
Medical Records - standards
Middle Aged
Patient Admission
Patient compliance
Pharmaceutical Preparations - administration & dosage - adverse effects
Physicians, Family
Prescriptions, Drug
Prospective Studies
Abstract
INTRODUCTION: A survey was conducted to evaluate the level of disagreement between the drug records of family doctors and information provided by patients at the time of hospitalisation. MATERIALS AND METHODS: One hundred patients acutely admitted to a hospital department of medicine were consecutively included if the patient ingested more than two non-OTC drugs. A second drug interview was performed shortly after admission, and the patient's current medication was recorded. If no written medical record from the referring family doctor was available at the time of admission, the doctor was contacted by phone for supplementary information. Discrepancies between the information given by the patient and the medical records of family doctors were recorded. The results were analysed blindly by two of the authors (one senior and one junior doctor) to determine if the discrepancies were clinically relevant for the patient. RESULTS: We found at least one clinically relevant and potentially dangerous discrepancy in the medical records of 40% (95% CI 30%-50%) of the patients. In all, discrepancies were found in the drug lists of 63% of the patients. The patients with discrepancies were similar in age, sex, way of hospitalization and number of drugs ingested, compared to those without discrepancies. Afterwards the family doctors were invited to a meeting in which these problems were evaluated. CONCLUSION: We conclude that there is an urgent need for improvement in the communication between the primary and secondary health care sectors concerning medication being prescribed for patients with chronic diseases. The large number of discrepancies in the drug records of patients in this study is discouraging.
PubMed ID
16579882 View in PubMed
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Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: a nationwide study in Denmark.

https://arctichealth.org/en/permalink/ahliterature267618
Source
Resuscitation. 2014 Sep;85(9):1161-8
Publication Type
Article
Date
Sep-2014
Author
Lena I M Karlsson
Mads Wissenberg
Emil L Fosbøl
Carolina Malta Hansen
Freddy K Lippert
Akshay Bagai
Bryan McNally
Christopher B Granger
Erika Frischknecht Christensen
Fredrik Folke
Shahzleen Rajan
Peter Weeke
Søren L Nielsen
Lars Køber
Gunnar H Gislason
Christian Torp-Pedersen
Source
Resuscitation. 2014 Sep;85(9):1161-8
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Circadian Rhythm
Denmark
Drug Therapy
Female
Humans
Incidence
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - complications - epidemiology
Time Factors
Abstract
To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA).
OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59.
We identified 18,929 OHCA patients, aged =18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12 min vs. 11 min and 11 min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p
PubMed ID
24971509 View in PubMed
Less detail

Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study.

https://arctichealth.org/en/permalink/ahliterature145748
Source
BMC Cardiovasc Disord. 2010;10:6
Publication Type
Article
Date
2010
Author
Rikke Sørensen
Steen Z Abildstrom
Peter Weeke
Emil L Fosbøl
Fredrik Folke
Morten L Hansen
Peter R Hansen
Jan K Madsen
Ulrik Abildgaard
Lars Køber
Henrik E Poulsen
Christian Torp-Pedersen
Gunnar H Gislason
Author Affiliation
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. rs@heart.dk
Source
BMC Cardiovasc Disord. 2010;10:6
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - mortality - trends
Cohort Studies
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality - prevention & control
Recurrence - prevention & control
Registries
Retrospective Studies
Risk factors
Ticlopidine - administration & dosage - analogs & derivatives
Time Factors
Treatment Outcome
Abstract
The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI) is unclear. We studied the risk of death or recurrent myocardial infarction (MI) in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI.
Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens.
The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference) for the composite endpoint of 1.01 (confidence intervals 0.81-1.26) and 1.24 (confidence intervals 0.95-1.62) for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06).
We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.
Notes
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PubMed ID
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