CBS 2019
CBSMD教育中心
English

急性冠脉综合征

科研文章

荐读文献

Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non-ST-Segment Elevation Acute Myocardial Infarction Direct comparison of cardiac myosin-binding protein C with cardiac troponins for the early diagnosis of acute myocardial infarction Long-Term Incremental Prognostic Value of Cardiovascular Magnetic Resonance After ST-Segment Elevation Myocardial Infarction A Study of the Collaborative Registry on CMR in STEMI 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Ca Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non-ST-Segment Elevation Acute Coronary Syndrome Letter by Jiang et al Regarding Article, “Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction” Patterns of use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers among patients with acute myocardial infarction in China from 2001 to 2011: China PEACE-Retrospective AMI Study Impact of Off-Hours Versus On-Hours Primary Percutaneous Coronary Intervention on Myocardial Damage and Clinical Outcomes in ST-Segment Elevation Myocardial Infarction Hospital Readmission After Perioperative Acute Myocardial Infarction Associated With Noncardiac Surgery Wearable Cardioverter-Defibrillator after 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.