期刊
EUROPEAN HEART JOURNAL
卷 38, 期 14, 页码 1048-1055A出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehw683
关键词
Prognosis; Myocardial infarction; Bleeding
资金
- AstraZeneca
- Medical Research Council Prognosis Research Strategy (PROGRESS) Partnership [G0902393/99558]
- Medical Research Council Population Health Scientist Fellowship [MR/M015084/1]
- Medical Research Council
- Arthritis Research UK
- British Heart Foundation
- Cancer Research UK
- Chief Scientist Office
- Economic and Social Research Council
- Engineering and Physical Sciences Research Council
- NIHR
- National Institute for Social Care and Health Research
- Wellcome Trust
- MRC [G0902393] Funding Source: UKRI
- British Heart Foundation [FS/14/76/30933] Funding Source: researchfish
- Medical Research Council [MR/K006584/1, MC_PC_13041, G0902393] Funding Source: researchfish
- National Institute for Health Research [05/40/04, CL-2011-11-003, RP-PG-0407-10314] Funding Source: researchfish
Aims The aim of this study is to develop models to aid the decision to prolong dual antiplatelet therapy (DAPT) that requires balancing an individual patient's potential benefits and harms Methods and results Using population-based electronic health records (EHRs) (CALIBER, England, 2000-10), of patients evaluated 1 year after acute myocardial infarction (MI), we developed (n= 12 694 patients) and validated (n= 5613) prognostic models for cardiovascular (cardiovascular death, MI or stroke) events and three different bleeding endpoints. We applied trial effect estimates to determine potential benefits and harms of DAPT and the net clinical benefit of individuals. Prognostic models for cardiovascular events (c-index: 0.75 (95% CI: 0.74, 0.77)) and bleeding (c index 0.72 (95% CI: 0.67, 0.77)) were well calibrated: 3-year risk of cardiovascular events was 16.5% overall (5.2% in the lowest-and 46.7% in the highest-risk individuals), while for major bleeding, it was 1.7% (0.3% in the lowest-and 5.4% in the highest-risk patients). For every 10 000 patients treated per year, we estimated 249 (95% CI: 228, 269) cardiovascular events prevented and 134 (95% CI: 87, 181) major bleeding events caused in the highest-risk patients, and 28 (95% CI: 19, 37) cardiovascular events prevented and 9 (95% CI: 0, 20) major bleeding events caused in the lowest-risk patients. There was a net clinical benefit of prolonged DAPT in 63-99% patients depending on how benefits and harms were weighted Conclusion Prognostic models for cardiovascular events and bleeding using population-based EHRs may help to personalise decisions for prolonged DAPT 1-year following acute MI.
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