David Brieger1, Stuart J Pocock2, Stefan Blankenberg3, Ji Yan Chen4, Mauricio G Cohen5, Christopher B Granger6, Richard Grieve2, Jose C Nicolau7, Tabassome Simon8, Dirk Westermann3, Satoshi Yasuda9, John Gregson2, Kirsten L Rennie10, Katarina Hedman11, Karolina Andersson Sundell11, Shaun G Goodman12. 1. Concord Hospital and University of Sydney, Sydney, Australia. Electronic address: david.brieger@health.nsw.gov.au. 2. London School of Hygiene and Tropical Medicine, London, United Kingdom. 3. Department of General and Interventional, University Heart Center Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Lübeck/Kiel, Hamburg, Germany. 4. Guangdong General Hospital, Provincial Key Laboratory of Coronary Disease, Guangzhou, China. 5. University of Miami Miller School of Medicine, Miami, FL, USA. 6. Duke Clinical Research Institute, Duke University Medical Center, Durham, USA. 7. Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. 8. Assistance Publique-Hopitaux de Paris (APHP), Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Paris, France; Sorbonne-Université (UPMC-Paris 06), Paris, France. 9. National Cerebral and Cardiovascular Center, Osaka, Japan. 10. London School of Hygiene and Tropical Medicine, London, United Kingdom; Oxon Epidemiology (United Kingdom), London, United Kingdom. 11. AstraZeneca, Gothenburg, Sweden. 12. Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Evidence is lacking on long-term outcomes in unselected patients surviving the first year following myocardial infarction (MI). METHODS AND RESULTS: The TIGRIS (long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients) prospective registry enrolled 9176 eligible patients aged ≥50 years, 1-3 years post-MI, from 25 countries. All had ≥1 risk factor: age ≥ 65 years, diabetes mellitus, second prior MI, multivessel coronary artery disease, chronic kidney disease (CKD). Primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death at 2-year follow-up. Bleeding requiring hospitalization was also recorded. 9027 patients (98.4%) provided follow-up data: the primary outcome occurred in 621 (7.0%), all-cause mortality in 295 (3.3%), and bleeding in 109 (1.2%) patients. Events accrued linearly over time. In multivariable analyses, qualifying risk factors were associated with increased risk of primary outcome (incidence rate ratio [RR] per 100 patient-years [95% confidence interval]): CKD 2.06 (1.66, 2.55), second prior MI 1.71 (1.38, 2.10), diabetes mellitus 1.63 (1.39, 1.92), age ≥ 65 years 1.53 (1.28, 1.83), and multivessel disease 1.24 (1.05, 1.48). Risk of bleeding events was greater in older patients (vs <65 years) 65-74 years 2.68 (1.53, 4.70), ≥75 years 4.62 (2.57, 8.28), and those with CKD 1.99 (1.18, 3.35). CONCLUSION: In stable patients recruited 1-3 years post-MI, recurrent cardiovascular and bleeding events accrued linearly over 2 years. Factors independently predictive of ischemic and bleeding events were identified, providing a context for deciding on treatment options.
BACKGROUND: Evidence is lacking on long-term outcomes in unselected patients surviving the first year following myocardial infarction (MI). METHODS AND RESULTS: The TIGRIS (long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarctionpatients) prospective registry enrolled 9176 eligible patients aged ≥50 years, 1-3 years post-MI, from 25 countries. All had ≥1 risk factor: age ≥ 65 years, diabetes mellitus, second prior MI, multivessel coronary artery disease, chronic kidney disease (CKD). Primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death at 2-year follow-up. Bleeding requiring hospitalization was also recorded. 9027 patients (98.4%) provided follow-up data: the primary outcome occurred in 621 (7.0%), all-cause mortality in 295 (3.3%), and bleeding in 109 (1.2%) patients. Events accrued linearly over time. In multivariable analyses, qualifying risk factors were associated with increased risk of primary outcome (incidence rate ratio [RR] per 100 patient-years [95% confidence interval]): CKD 2.06 (1.66, 2.55), second prior MI 1.71 (1.38, 2.10), diabetes mellitus 1.63 (1.39, 1.92), age ≥ 65 years 1.53 (1.28, 1.83), and multivessel disease 1.24 (1.05, 1.48). Risk of bleeding events was greater in older patients (vs <65 years) 65-74 years 2.68 (1.53, 4.70), ≥75 years 4.62 (2.57, 8.28), and those with CKD 1.99 (1.18, 3.35). CONCLUSION: In stable patients recruited 1-3 years post-MI, recurrent cardiovascular and bleeding events accrued linearly over 2 years. Factors independently predictive of ischemic and bleeding events were identified, providing a context for deciding on treatment options.
Authors: Stuart Pocock; David B Brieger; Ruth Owen; Jiyan Chen; Mauricio G Cohen; Shaun Goodman; Christopher B Granger; José C Nicolau; Tabassome Simon; Dirk Westermann; Satoshi Yasuda; Katarina Hedman; Carl Mellström; Karolina Andersson Sundell; Richard Grieve Journal: Open Heart Date: 2021-02
Authors: Demetria Hubbard; Lisandro D Colantonio; Robert S Rosenson; Todd M Brown; Elizabeth A Jackson; Lei Huang; Kate K Orroth; Stephanie Reading; Mark Woodward; Vera Bittner; Orlando M Gutierrez; Monika M Safford; Michael E Farkouh; Paul Muntner Journal: Cardiovasc Diabetol Date: 2021-03-01 Impact factor: 9.951