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Open sesame technique in percutaneous coronary intervention for ST-elevation myocardial infarction The Prognostic Significance of Periprocedural Infarction in the Era of Potent Antithrombotic Therapy: The PRAGUE-18 Substudy Prevalence and Prognosis of Unrecognized Myocardial Infarction Determined by Cardiac Magnetic Resonance in Older Adults Comparative Effectiveness of β-Blocker Use Beyond 3 Years After Myocardial Infarction and Long-Term Outcomes Among Elderly Patients Linking Spontaneous Coronary Artery Dissection, Cervical Artery Dissection, and Fibromuscular Dysplasia: Heart, Brain, and Kidneys Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies Another Nail in the Coffin for Intra-Aortic Balloon Counterpulsion in Acute Myocardial Infarction With Cardiogenic Shock Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study Intensive Care Utilization in Stable Patients With ST-Segment Elevation Myocardial Infarction Treated With Rapid Reperfusion Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction

Clinical TrialVolume 72, Issue 1, July 2018

JOURNAL:J Am Coll Cardiol. Article Link

Risk of Myocardial Infarction in Anticoagulated Patients With Atrial Fibrillation

C J-Y Lee, TA Gerds, N Carlson et al. Keywords: apixaban; dabigatran; direct oral anticoagulant; rivaroxaban; vitamin K antagonist

Abstract


BACKGROUND - Evidence is conflicting as to the efficacy of direct oral anticoagulation (DOAC) and vitamin K antagonist (VKA) for prevention of myocardial infarction (MI).

OBJECTIVES - This study aimed to investigate the risk of MI associated with the use of apixaban, dabigatran, rivaroxaban, and VKA in patients with atrial fibrillation.

METHODS - Patients with atrial fibrillation were identified using Danish health care registers and stratified by initial oral anticoagulant treatment. Standardized absolute 1-year risks were estimated based on Cox regression for hazard rates of MI hospitalizations and mortality. Reported were absolute risks separately for the oral anticoagulation treatments and standardized to the characteristics of the study population.

RESULTS - Of the 31,739 patients included (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6% (95% confidence interval [CI]: 1.3 to 1.8), apixaban was 1.2% (95% CI: 0.9 to 1.4), dabigatran was 1.2% (95% CI: 1.0 to 1.5), and rivaroxaban was 1.1% (95% CI: 0.8 to 1.3). No significant risk differences were observed in the standardized 1-year risks of MI among the DOACs: dabigatran versus apixaban (0.04%; 95% CI: −0.3 to 0.4), rivaroxaban versus apixaban (0.1%; 95% CI: −0.4 to 0.3), and rivaroxaban versus dabigatran (−0.1%; 95% CI: −0.5 to 0.2). The risk differences for DOACs versus VKA were all significant: −0.4% (95% CI: −0.7 to −0.1) for apixaban, −0.4% (95% CI: −0.7 to −0.03) for dabigatran, and −0.5% (95% CI: −0.8 to −0.2) for rivaroxaban.

CONCLUSIONS - No significant risk differences of MI were found in the direct comparisons of DOACs, and DOACs were all associated with a significant risk reduction of MI compared with VKA.