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Anticoagulation for the Prevention of Arterial Thromboembolism in Cancer Patients by Primary Tumor Site: A Systematic Review and Meta-Analysis of Randomized Trials. 按原发肿瘤部位划分的癌症患者预防动脉血栓栓塞症的抗凝治疗:随机试验的系统回顾和元分析》。
IF 7.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1093/ehjcvp/pvae068
Yan Xu,Caroline Mallity,Erin Collins,Deborah M Siegal,Tzu-Fei Wang,Marc Carrier
AIMSIncidence of arterial thromboembolism (ATE) among ambulatory cancer patients varies by primary tumor site. However, it is unclear whether this alters the benefit-to-harm profile of prophylactic anticoagulation for ATE prevention. Therefore, we systematically evaluated the efficacy and safety of anticoagulants for ATE prevention among ambulatory cancer patients according to the primary tumor site.METHODS AND RESULTSWe conducted a systematic review using Medline, Embase, SCOPUS, and CENTRAL, and included randomized trials comparing prophylactic anticoagulation to no anticoagulation among ambulatory cancer patients who initiated tumor-directed systemic therapy. Incidence of symptomatic ATE (acute ischemic stroke, acute myocardial infarction or peripheral artery occlusion) and major bleeding, as well as risk differences (RDs) attributable to anticoagulation were meta-analyzed by primary tumor site using random-effects modeling. We included 10 randomized controlled trials with 9,875 patients with follow-up ranging from 3.3 to 68 (median 6.6) months. While prophylactic anticoagulation did not reduce ATE risks overall (RD -0.49%; 95% CI -0.49% to 0.01%; I2=0%), it conferred a protective effect among pancreatic cancer patients (RD -3.2%; 95%CI -5.7% to -0.8%; I2=0%) without a detectable increase in major bleeding (RD -1.4%; 95% CI -4.6% to 1.8%; I2=0%). Prophylactic anticoagulation was not associated with ATE risk reduction in other tumor sites.CONCLUSIONBased on available evidence, prophylactic anticoagulation did not reduce ATE risk among ambulatory cancer patients overall. However, we observed lower incidence of ATE among pancreatic cancer patients randomized to receive anticoagulation. Prophylactic anticoagulant use to reduce ATEs in pancreatic cancer should be evaluated in future research.
摘要门诊癌症患者的动脉血栓栓塞症(ATE)发病率因原发肿瘤部位而异。然而,目前还不清楚这是否会改变预防性抗凝治疗对预防 ATE 的利弊分析。因此,我们根据原发肿瘤部位系统地评估了非卧床癌症患者使用抗凝剂预防 ATE 的有效性和安全性。方法和结果我们使用 Medline、Embase、SCOPUS 和 CENTRAL 进行了系统性回顾,纳入了在开始接受肿瘤指导的全身治疗的非卧床癌症患者中比较预防性抗凝与无抗凝的随机试验。我们使用随机效应模型按原发肿瘤部位对无症状 ATE(急性缺血性中风、急性心肌梗死或外周动脉闭塞)和大出血的发生率以及抗凝引起的风险差异 (RD) 进行了元分析。我们纳入了 10 项随机对照试验,共有 9875 名患者参加,随访时间从 3.3 个月到 68 个月(中位数为 6.6 个月)不等。虽然预防性抗凝治疗并未降低总体ATE风险(RD -0.49%;95% CI -0.49%至0.01%;I2=0%),但它对胰腺癌患者具有保护作用(RD -3.2%;95%CI -5.7%至-0.8%;I2=0%),且未发现大出血增加(RD -1.4%;95% CI -4.6%至1.8%;I2=0%)。结论根据现有证据,预防性抗凝并不能降低门诊癌症患者的 ATE 风险。但是,我们观察到随机接受抗凝治疗的胰腺癌患者的 ATE 发生率较低。在未来的研究中,应该对预防性抗凝剂的使用以减少胰腺癌患者的 ATE 进行评估。
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引用次数: 0
OCEANIC-AF trial: factor XI inhibitors revolution in atrial fibrillation is on hold. OCEANIC-AF试验:XI因子抑制剂在心房颤动中的革命被搁置。
IF 7.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-10 DOI: 10.1093/ehjcvp/pvae065
Felice Gragnano,Antonio Capolongo,Mattia Galli,Paolo Calabrò
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引用次数: 0
Effects of beta-blockers on quality of life and well-being in patients with myocardial infarction and preserved left ventricular function-a prespecified substudy from REDUCE-AMI. β-受体阻滞剂对心肌梗死和左心室功能保留患者生活质量和幸福感的影响--REDUCE-AMI 的一项预设子研究。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1093/ehjcvp/pvae062
Katarina Mars, Sophia Humphries, Philip Leissner, Martin Jonsson, Patric Karlström, Jörg Lauermann, Joakim Alfredsson, Thomas Kellerth, Annica Ravn-Fischer, David Erlinge, Bertil Lindahl, Troels Yndigegn, Tomas Jernberg, Claes Held, Erik M G Olsson, Robin Hofmann

Aims: In the Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction (REDUCE-AMI) study, long-term beta-blocker use in patients after acute myocardial infarction (AMI) with preserved left ventricular ejection fraction demonstrated no effect on death or cardiovascular outcomes. The aim of this prespecified substudy was to investigate effects of beta-blockers on self-reported quality of life and well-being.

Methods and results: From this parallel-group, open-label, registry-based randomized clinical trial, EQ-5D, and World Health Organization well-being index-5 (WHO-5) questionnaires were obtained at 6-10 weeks and 11-13 months after AMI in 4080 and 806 patients, respectively. We report results from intention-to-treat and on-treatment analyses for the overall population and relevant subgroups using Wilcoxon rank sum test and adjusted ordinal regression analyses. Of the 4080 individuals reporting EQ-5D (median age 64 years, 22% female), 2023 were randomized to beta-blockers. The main outcome, median EQ-5D index score, was 0.94 [interquartile range (IQR) 0.88, 0.97] in the beta-blocker group, and 0.94 (IQR 0.88, 0.97) in the no-beta-blocker group 6-10 weeks after AMI, OR 1.00 [95% CI 0.89-1.13; P > 0.9]. After 11-13 months, results remained unchanged. Findings were robust in on-treatment analyses and across relevant subgroups. Secondary outcomes, EQ-VAS and WHO-5 index score, confirmed these results.

Conclusion: Among patients after AMI with preserved left ventricular ejection fraction, self-reported quality of life and well-being was not significantly different in individuals randomized to routine long-term beta-blocker therapy as compared to individuals with no beta-blocker use. These results appear consistent regardless of adherence to randomized treatment and across subgroups which emphasizes the need for a careful individual risk-benefit evaluation prior to initiation of beta-blocker treatment.

目的:在急性心肌梗死后减少使用β-受体阻滞剂的随机评估(REDUCE-AMI)研究中,左心室射血分数保留的急性心肌梗死(AMI)患者长期使用β-受体阻滞剂对死亡或心血管预后没有影响。这项预先指定的子研究旨在调查β-受体阻滞剂对自我报告的生活质量和幸福感的影响:在这项平行分组、开放标签、基于登记的随机临床试验中,分别对 4080 名和 806 名急性心肌梗死患者在术后 6-10 周和 11-13 个月进行了 EQ-5D 和世界卫生组织幸福指数-5(WHO-5)问卷调查。我们采用 Wilcoxon 秩和检验和调整后的序数回归分析,报告了总体人群和相关亚群的意向治疗分析和治疗分析结果。在报告 EQ-5D 的 4080 名患者(中位年龄为 64 岁,22% 为女性)中,有 2023 人随机接受了β-受体阻滞剂治疗。主要结果,即急性心肌梗死后 6-10 周,β-受体阻滞剂组的 EQ-5D 指数得分中位数为 0.94 [四分位数间距 (IQR) 0.88, 0.97],无β-受体阻滞剂组为 0.94 (IQR 0.88, 0.97),OR 1.00 [95% CI 0.89-1.13; P > 0.9]。11-13 个月后,结果保持不变。在治疗分析和相关亚组中,结果都很可靠。次要结果、EQ-VAS和WHO-5指数评分证实了这些结果:结论:在左心室射血分数保留的急性心肌梗死患者中,随机接受常规长期β-受体阻滞剂治疗的患者与不使用β-受体阻滞剂的患者相比,自我报告的生活质量和幸福感没有显著差异。无论是否坚持随机治疗以及在不同的亚组中,这些结果似乎都是一致的,这就强调了在开始β-受体阻滞剂治疗之前,需要对个体进行仔细的风险-效益评估。
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引用次数: 0
The four-item PRECISE-DAPT score identifies coronary artery bypass grafting patients with increased risk for post-discharge major bleeding. 四项 PRECISE-DAPT 评分可识别出出院后大出血风险较高的冠状动脉旁路移植术患者。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-20 DOI: 10.1093/ehjcvp/pvae060
Philip Enström, Andreas Martinsson, Mary Rezk, Susanne Nielsen, Erik Björklund, Maya Landenhed-Smith, Emily Pan, Anders Jeppsson

Aims: Early identification of patients with increased bleeding risk increases the possibility to individualize antithrombotic treatment. We validated the PRECISE-DAPT score, originally developed to estimate bleeding risk in patients on dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), in coronary artery bypass grafting (CABG) patients.

Methods and results: All patients who underwent first time, isolated CABG in Sweden 2009-2020 and survived until discharge were included. The four-item PRECISE-DAPT score, based on age, estimated glomerular filtration rate, preoperative haemoglobin concentration, and previous spontaneous bleeding, was calculated in patients discharged on DAPT (n = 6 838), or antiplatelet monotherapy (n = 15 406). High bleeding risk was defined as a score ≥ 25 in accordance with previous studies and major bleeding as hospitalization due to bleeding. Associations were assessed by C-statistics and Cox regression models.Major bleeding occurred during the first postoperative year in 130 patients (1.9%) in the DAPT group, and in 197 patients (1.3%) in the monotherapy group. The score identified 32.9% of the patients in the DAPT group and 38.2% in monotherapy groups as having high bleeding risk. The area under the ROC-curve for the score was 0.67 (95%CI 0.62-0.72) for DAPT and 0.71 (0.67-0.74) for monotherapy. The hazard ratio for high bleeding risk vs. very low risk was 4.14 (2.07-8.26) for DAPT patients, and 4.95 (2.61-9.39) for monotherapy patients, both p < 0.001.

Conclusions: The PRECISE-DAPT identifies patients with increased risk for major bleeding after discharge following CABG with moderate accuracy. The accuracy is comparable to what previously has been reported for patients after PCI.

目的:早期识别出血风险增加的患者可提高个体化抗血栓治疗的可能性。我们在冠状动脉旁路移植术(CABG)患者中验证了 PRECISE-DAPT 评分,该评分最初是用于估计经皮冠状动脉介入术(PCI)后接受双联抗血小板疗法(DAPT)患者的出血风险:纳入 2009-2020 年在瑞典首次接受孤立 CABG 手术并存活至出院的所有患者。根据年龄、估计肾小球滤过率、术前血红蛋白浓度和既往自发性出血情况,计算出出院后接受 DAPT(6 838 人)或抗血小板单药治疗(15 406 人)的患者的四项 PRECISE-DAPT 评分。根据以往的研究,出血风险高的定义是得分≥25,大出血是指因出血而住院。DAPT组有130名患者(1.9%)在术后第一年发生大出血,而单一疗法组有197名患者(1.3%)发生大出血。该评分确定了 32.9% 的 DAPT 组患者和 38.2% 的单一疗法组患者有高出血风险。DAPT和单一疗法的评分ROC曲线下面积分别为0.67(95%CI 0.62-0.72)和0.71(0.67-0.74)。DAPT患者的高出血风险与极低风险的危险比为4.14(2.07-8.26),单一疗法患者的危险比为4.95(2.61-9.39),均为P 结论:PRECISE-DAPT 能识别出 CABG 术后出院后大出血风险增加的患者,准确率中等。其准确性与之前报道的 PCI 术后患者的准确性相当。
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引用次数: 0
Aspirin-free strategy for percutaneous coronary intervention in acute coronary syndrome based on the subtypes of acute coronary syndrome and high bleeding risk: the STOPDAPT-3 trial. 基于急性冠脉综合征亚型和高出血风险的急性冠脉综合征经皮冠状动脉介入治疗无阿司匹林策略:STOPDAPT-3 试验。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-14 DOI: 10.1093/ehjcvp/pvae009
Yuki Obayashi, Masahiro Natsuaki, Hirotoshi Watanabe, Takeshi Morimoto, Ko Yamamoto, Ryusuke Nishikawa, Kenji Ando, Satoru Suwa, Tsuyoshi Isawa, Hiroyuki Takenaka, Tetsuya Ishikawa, Hideo Tokuyama, Hiroki Sakamoto, Takanari Fujita, Mamoru Nanasato, Hideki Okayama, Tenjin Nishikura, Hidekuni Kirigaya, Koji Nishida, Koh Ono, Takeshi Kimura

Background and aims: High bleeding risk (HBR) and acute coronary syndrome (ACS) subtypes are critical in determining bleeding and cardiovascular event risk after percutaneous coronary intervention (PCI).

Methods and results: In 4476 ACS patients enrolled in the STOPDAPT-3, where the no-aspirin and dual antiplatelet therapy (DAPT) strategies after PCI were randomly compared, the pre-specified subgroup analyses were conducted based on HBR/non-HBR and ST-segment elevation myocardial infarction (STEMI)/non-ST-segment elevation ACS (NSTE-ACS). The co-primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5, and the co-primary cardiovascular endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischaemic stroke at 1 month. Irrespective of the subgroups, the effect of no-aspirin compared with DAPT was not significant for the bleeding endpoint (HBR [N = 1803]: 7.27 and 7.91%, hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.65-1.28; non-HBR [N = 2673]: 3.40 and 3.65%, HR 0.93, 95% CI 0.62-1.39; Pinteraction = 0.94; STEMI [N = 2553]: 6.58 and 6.56%, HR 1.00, 95% CI 0.74-1.35; NSTE-ACS [N = 1923]: 2.94 and 3.64%, HR 0.80, 95% CI 0.49-1.32; Pinteraction = 0.45), and for the cardiovascular endpoint (HBR: 7.87 and 5.75%, HR 1.39, 95% CI 0.97-1.99; non-HBR: 2.56 and 2.67%, HR 0.96, 95% CI 0.60-1.53; Pinteraction = 0.22; STEMI: 6.07 and 5.46%, HR 1.11, 95% CI 0.81-1.54; NSTE-ACS: 3.03 and 1.71%, HR 1.78, 95% CI 0.97-3.27; Pinteraction = 0.18).

Conclusion: In patients with ACS undergoing PCI, the no-aspirin strategy compared with the DAPT strategy failed to reduce major bleeding events irrespective of HBR and ACS subtypes. The numerical excess risk of the no-aspirin strategy relative to the DAPT strategy for cardiovascular events was observed in patients with HBR and in patients with NSTE-ACS.

背景与目的高出血风险(HBR)和急性冠状动脉综合征(ACS)亚型是决定经皮冠状动脉介入治疗(PCI)后出血和心血管事件风险的关键:STOPDAPT-3随机比较了PCI术后禁用阿司匹林和双联抗血小板疗法(DAPT)的策略,在入选STOPDAPT-3的4476例ACS患者中,根据HBR/非HBR和ST段抬高型心肌梗死(STEMI)/非ST段抬高型ACS(NSTE-ACS)进行了预先指定的亚组分析。共同主要出血终点为 BARC 3 型或 5 型,共同主要心血管终点为 1 个月时心血管死亡、心肌梗死、明确的支架血栓或缺血性卒中的复合终点:无论在哪个亚组,与 DAPT 相比,无阿司匹林对出血终点的影响都不显著(HBR [N = 1803]:7.27% 和 7.91%,HR 0.91,95%CI 0.65-1.28;非 HBR [N = 2673]:3.40% 和 3.65%,HR 0.91,95%CI 0.65-1.28):在心血管终点方面(HBR:7.87%和5.75%,HR 0.93,95%CI 0.62-1.39;Pinteraction = 0.94;STEMI [N=2553]:6.58%和6.56%,HR 1.00,95%CI 0.74-1.35;NSTE-ACS [N=1923]:2.94%和3.64%,HR 0.80,95%CI 0.49-1.32;Pinteraction = 0.45),非HBR:3.40%和3.65%,HR 0.93,95%CI 0.62-1.39;Pinteraction = 0.94。87%和5.75%,HR 1.39,95%CI 0.97-1.99;非HBR:2.56%和2.67%,HR 0.96,95%CI 0.60-1.53;Pinteraction = 0.22;STEMI:6.07%和5.46%,HR 1.11,95%CI 0.81-1.54;NSTE-ACS:3.03%和1.71%,HR 1.78,95%CI 0.97-3.27;Pinteraction = 0.18):在接受PCI治疗的ACS患者中,无论HBR和ACS亚型如何,与DAPT策略相比,无阿司匹林策略未能减少大出血事件。在HBR患者和NSTE-ACS患者中观察到,相对于DAPT策略,无阿司匹林策略在心血管事件方面的超额风险在数值上高于DAPT策略。
{"title":"Aspirin-free strategy for percutaneous coronary intervention in acute coronary syndrome based on the subtypes of acute coronary syndrome and high bleeding risk: the STOPDAPT-3 trial.","authors":"Yuki Obayashi, Masahiro Natsuaki, Hirotoshi Watanabe, Takeshi Morimoto, Ko Yamamoto, Ryusuke Nishikawa, Kenji Ando, Satoru Suwa, Tsuyoshi Isawa, Hiroyuki Takenaka, Tetsuya Ishikawa, Hideo Tokuyama, Hiroki Sakamoto, Takanari Fujita, Mamoru Nanasato, Hideki Okayama, Tenjin Nishikura, Hidekuni Kirigaya, Koji Nishida, Koh Ono, Takeshi Kimura","doi":"10.1093/ehjcvp/pvae009","DOIUrl":"10.1093/ehjcvp/pvae009","url":null,"abstract":"<p><strong>Background and aims: </strong>High bleeding risk (HBR) and acute coronary syndrome (ACS) subtypes are critical in determining bleeding and cardiovascular event risk after percutaneous coronary intervention (PCI).</p><p><strong>Methods and results: </strong>In 4476 ACS patients enrolled in the STOPDAPT-3, where the no-aspirin and dual antiplatelet therapy (DAPT) strategies after PCI were randomly compared, the pre-specified subgroup analyses were conducted based on HBR/non-HBR and ST-segment elevation myocardial infarction (STEMI)/non-ST-segment elevation ACS (NSTE-ACS). The co-primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5, and the co-primary cardiovascular endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischaemic stroke at 1 month. Irrespective of the subgroups, the effect of no-aspirin compared with DAPT was not significant for the bleeding endpoint (HBR [N = 1803]: 7.27 and 7.91%, hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.65-1.28; non-HBR [N = 2673]: 3.40 and 3.65%, HR 0.93, 95% CI 0.62-1.39; Pinteraction = 0.94; STEMI [N = 2553]: 6.58 and 6.56%, HR 1.00, 95% CI 0.74-1.35; NSTE-ACS [N = 1923]: 2.94 and 3.64%, HR 0.80, 95% CI 0.49-1.32; Pinteraction = 0.45), and for the cardiovascular endpoint (HBR: 7.87 and 5.75%, HR 1.39, 95% CI 0.97-1.99; non-HBR: 2.56 and 2.67%, HR 0.96, 95% CI 0.60-1.53; Pinteraction = 0.22; STEMI: 6.07 and 5.46%, HR 1.11, 95% CI 0.81-1.54; NSTE-ACS: 3.03 and 1.71%, HR 1.78, 95% CI 0.97-3.27; Pinteraction = 0.18).</p><p><strong>Conclusion: </strong>In patients with ACS undergoing PCI, the no-aspirin strategy compared with the DAPT strategy failed to reduce major bleeding events irrespective of HBR and ACS subtypes. The numerical excess risk of the no-aspirin strategy relative to the DAPT strategy for cardiovascular events was observed in patients with HBR and in patients with NSTE-ACS.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"374-390"},"PeriodicalIF":5.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139574386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
GPVI inhibition: Advancing antithrombotic therapy in cardiovascular disease. 将 GPVI 作为有效的抗血栓靶点。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-14 DOI: 10.1093/ehjcvp/pvae018
Alexandre Slater, Sophia Khattak, Mark R Thomas

Glycoprotein (GP) VI (GPVI) plays a major role in thrombosis but not haemostasis, making it a promising antithrombotic target. The primary role of GPVI on the surface of platelets is a signalling receptor for collagen, which is one of the most potent thrombotic sub-endothelial components that is exposed by atherosclerotic plaque rupture. Inhibition of GPVI has therefore been investigated as a strategy for treatment and prevention of atherothrombosis, such as during stroke and acute coronary syndromes. A range of specific GPVI inhibitors have been characterized, and two of these inhibitors, glenzocimab and revacept, have completed Phase II clinical trials in ischaemic stroke. In this review, we summarize mechanisms of GPVI activation and the latest progress of clinically tested GPVI inhibitors, including their mechanisms of action. By focusing on what is known about GPVI activation, we also discuss whether alternate strategies could be used to target GPVI.

糖蛋白(GP)VI 在血栓形成中起着重要作用,但不止血,因此是一个很有前景的抗血栓靶点。GPVI 在血小板表面的主要作用是作为胶原蛋白的信号受体,而胶原蛋白是动脉粥样硬化斑块破裂时暴露出来的最有效的血栓形成内皮下成分之一。因此,人们将抑制 GPVI 作为治疗和预防动脉粥样硬化血栓形成(如中风和急性冠状动脉综合征)的一种策略进行了研究。一系列特异性 GPVI 抑制剂已被证实,其中两种抑制剂--格仑珠单抗和雷帕塞已完成缺血性中风的 II 期临床试验。在本综述中,我们总结了 GPVI 的激活机制和临床试验 GPVI 抑制剂的最新进展,包括其作用机制。我们将重点放在已知的 GPVI 激活机制上,并讨论是否也可以采用其他策略来靶向 GPVI。
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引用次数: 0
Re: Shahim et al., 2024 "Cholinesterase inhibitors are associated with reduced mortality in patients with Alzheimer's disease and previous myocardial infarction". Re:Shahim 等人,2024 胆碱酯酶抑制剂与降低阿尔茨海默病患者和既往心肌梗塞患者的死亡率有关。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-14 DOI: 10.1093/ehjcvp/pvae041
Arina A Tamborska, Charles F Bray, Tobias Kurth
{"title":"Re: Shahim et al., 2024 \"Cholinesterase inhibitors are associated with reduced mortality in patients with Alzheimer's disease and previous myocardial infarction\".","authors":"Arina A Tamborska, Charles F Bray, Tobias Kurth","doi":"10.1093/ehjcvp/pvae041","DOIUrl":"10.1093/ehjcvp/pvae041","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"476-477"},"PeriodicalIF":5.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safety and effectiveness of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: insights from the SPUM-ACS study. 糖蛋白 IIb/IIIa 抑制剂在急性冠状动脉综合征中的安全性和有效性:SPUM-ACS 研究的启示。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-14 DOI: 10.1093/ehjcvp/pvae024
Francesco Bruno, Florian A Wenzl, Ovidio De Filippo, Simon Kraler, Federico Giacobbe, Marco Roffi, Olivier Muller, Lorenz Räber, Christian Templin, Gaetano Maria De Ferrari, Fabrizio D'Ascenzo, Thomas F Lüscher

Aims: Data on glycoprotein IIb/IIIa inhibitor (GPI) use in real-world acute coronary syndrome (ACS) patients following the introduction of potent P2Y12 inhibitors and newer-generation stents are scant. Here, we aimed to assess the utilization, effectiveness, and safety of GPI in a large prospective multicentre cohort of contemporary ACS patients.

Methods and results: SPUM-ACS prospectively recruited patients presenting with ACS between 2009 and 2017. The primary endpoint of the present study was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke at 1 year. Secondary endpoints were defined as any bleeding events, Bleeding Academic Research Consortium (BARC) 3-5 bleeding, and net adverse cardiovascular events (NACE). A total of 4395 ACS patients were included in the analysis. GPI-treated patients had more total coronary artery occlusion (56% vs. 35%, P < 0.001) and thrombus (60% vs. 35%, P < 0.001) at angiography. Among the propensity score-matched (PSM) population (1992 patients equally split into two groups), GPI-treated patients showed lower risk of MACE [PSM adjusted hazard ratio (HR) 0.70, 95% CI 0.49-0.99], but a higher risk of any (PSM adjusted HR 1.46, 95% CI 1.06-1.99) and major bleedings (PSM adjusted HR 1.73, 95% CI 1.09-2.76), resulting in a neutral effect on NACE (PSM adjusted HR 0.87, 95% CI 0.65-1.17). These results remained consistent across all subgroups.

Conclusions: In patients with ACS undergoing percutaneous coronary intervention and receiving potent P2Y12 inhibitors, we observed a reduced risk of MACE and an increased risk of major bleedings at 1 year in patients treated with GPI. Although the routine use of GPI is currently not recommended, they might be considered in selected patients following a personalized balancing between ischaemic and bleeding risks.

目的:在强效P2Y12抑制剂和新一代支架问世后,有关糖蛋白IIb/IIIa抑制剂(GPI)在实际ACS患者中使用情况的数据很少。在此,我们旨在评估 GPI 在当代 ACS 患者大型前瞻性多中心队列中的使用情况、有效性和安全性:SPUM-ACS前瞻性地招募了2009年至2017年间的ACS患者。本研究的主要终点是主要不良心血管事件(MACE),即一年内全因死亡、非致死性心肌梗死(MI)和非致死性卒中的复合终点。次要终点定义为任何出血事件、BARC 3-5 级出血和净不良心血管事件(NACE)。共有 4395 名 ACS 患者被纳入分析。GPI治疗患者的冠状动脉全闭塞率更高(56% vs 35%,pConclusion):在接受 PCI 并接受强效 P2Y12 抑制剂治疗的 ACS 患者中,我们观察到接受 GPI 治疗的患者 MACE 风险降低,1 年后大出血风险增加。虽然目前不建议常规使用 GPI,但在平衡缺血和出血风险后,可考虑在特定患者中使用 GPI。
{"title":"Safety and effectiveness of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: insights from the SPUM-ACS study.","authors":"Francesco Bruno, Florian A Wenzl, Ovidio De Filippo, Simon Kraler, Federico Giacobbe, Marco Roffi, Olivier Muller, Lorenz Räber, Christian Templin, Gaetano Maria De Ferrari, Fabrizio D'Ascenzo, Thomas F Lüscher","doi":"10.1093/ehjcvp/pvae024","DOIUrl":"10.1093/ehjcvp/pvae024","url":null,"abstract":"<p><strong>Aims: </strong>Data on glycoprotein IIb/IIIa inhibitor (GPI) use in real-world acute coronary syndrome (ACS) patients following the introduction of potent P2Y12 inhibitors and newer-generation stents are scant. Here, we aimed to assess the utilization, effectiveness, and safety of GPI in a large prospective multicentre cohort of contemporary ACS patients.</p><p><strong>Methods and results: </strong>SPUM-ACS prospectively recruited patients presenting with ACS between 2009 and 2017. The primary endpoint of the present study was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke at 1 year. Secondary endpoints were defined as any bleeding events, Bleeding Academic Research Consortium (BARC) 3-5 bleeding, and net adverse cardiovascular events (NACE). A total of 4395 ACS patients were included in the analysis. GPI-treated patients had more total coronary artery occlusion (56% vs. 35%, P < 0.001) and thrombus (60% vs. 35%, P < 0.001) at angiography. Among the propensity score-matched (PSM) population (1992 patients equally split into two groups), GPI-treated patients showed lower risk of MACE [PSM adjusted hazard ratio (HR) 0.70, 95% CI 0.49-0.99], but a higher risk of any (PSM adjusted HR 1.46, 95% CI 1.06-1.99) and major bleedings (PSM adjusted HR 1.73, 95% CI 1.09-2.76), resulting in a neutral effect on NACE (PSM adjusted HR 0.87, 95% CI 0.65-1.17). These results remained consistent across all subgroups.</p><p><strong>Conclusions: </strong>In patients with ACS undergoing percutaneous coronary intervention and receiving potent P2Y12 inhibitors, we observed a reduced risk of MACE and an increased risk of major bleedings at 1 year in patients treated with GPI. Although the routine use of GPI is currently not recommended, they might be considered in selected patients following a personalized balancing between ischaemic and bleeding risks.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"391-402"},"PeriodicalIF":5.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Oral anticoagulation in patients with left ventricular thrombus: a systematic review and meta-analysis. 左心室血栓患者的口服抗凝药--系统回顾和荟萃分析。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-14 DOI: 10.1093/ehjcvp/pvae042
Paul M Haller, Niema Kazem, Stefan Agewall, Claudio Borghi, Claudio Ceconi, Dobromir Dobrev, Elisabetta Cerbai, Erik Lerkevang Grove, Juan Carlos Kaski, Basil S Lewis, Alexander Niessner, Bianca Rocca, Giuseppe Rosano, Gianluigi Savarese, Renate B Schnabel, Anne Grete Semb, Samuel Sossalla, Sven Wassmann, Patrick Sulzgruber

Aims: Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analysed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety.

Methods: We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs vs. VKAs in patients with LVT. Endpoints of interest were stroke or systemic embolism, thrombus resolution, all-cause death, and a composite bleeding endpoint. Estimates were pooled using a random-effects model meta-analysis, and their robustness was investigated using sensitivity and influential analyses.

Results: We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3587 patients (2489 VKA vs. 1098 DOAC therapy). The pooled estimates for stroke or systemic embolism [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.57, 1.15] and thrombus resolution (OR: 1.12; 95% CI: 0.86, 1.46) were comparable, and there was low heterogeneity overall across the included studies. The use of DOACs was associated with lower odds of all-cause death (OR: 0.65; 95% CI: 0.46, 0.92) and a composite bleeding endpoint (OR: 0.67; 95% CI: 0.47, 0.97). A risk of bias was evident particularly for observational reports, with some publication bias suggested in funnel plots.

Conclusion: In this comprehensive analysis of mainly observational data, the use of DOACs was not associated with a significant difference in stroke or systemic embolism, or thrombus resolution, compared with VKA therapy. The use of DOACs was associated with a lower rate of all-cause death and fewer bleeding events. Adequately sized randomized clinical trials are needed to confirm these findings, which could allow a wider adoption of DOACs in patients with LVT.

目的:直接口服抗凝剂(DOAC)越来越多地被用于治疗左心室血栓(LVT)患者。我们分析了现有的荟萃数据,比较了 DOAC 和维生素 K 拮抗剂(VKAs)的疗效和安全性:我们对 LVT 患者中 DOAC 与 VKAs 比较的观察性和随机数据进行了系统检索和荟萃分析。研究终点为中风或全身性栓塞、血栓溶解、全因死亡和综合出血终点。使用随机效应模型荟萃分析对估计值进行汇总,并使用敏感性分析和影响分析对其稳健性进行研究:我们确定了 22 篇文章(18 项观察性研究、4 项小型随机临床试验),共报告了 3,587 名患者(2,489 名患者接受 VKA 治疗,1,098 名患者接受 DOAC 治疗)。中风或全身性栓塞(OR 0.81;95% CI [0.57,1.15])和血栓溶解(OR 1.12;95% CI [0.86,1.46])的汇总估计值相当,纳入研究的总体异质性较低。使用 DOAC 可降低全因死亡几率(OR 0.65;95%CI [0.46;0.92])和复合出血终点(OR 0.67;95%CI [0.47;0.97])。特别是观察性报告存在明显的偏倚风险,漏斗图显示了一些发表偏倚:在这项以观察性数据为主的综合分析中,与 VKA 治疗相比,使用 DOACs 与中风、全身性栓塞或血栓溶解的显著差异无关。使用 DOACs 与较低的全因死亡率和较少的出血事件有关。需要进行足够规模的随机临床试验来证实这些研究结果,这样才能在 LVT 患者中更广泛地采用 DOACs。
{"title":"Oral anticoagulation in patients with left ventricular thrombus: a systematic review and meta-analysis.","authors":"Paul M Haller, Niema Kazem, Stefan Agewall, Claudio Borghi, Claudio Ceconi, Dobromir Dobrev, Elisabetta Cerbai, Erik Lerkevang Grove, Juan Carlos Kaski, Basil S Lewis, Alexander Niessner, Bianca Rocca, Giuseppe Rosano, Gianluigi Savarese, Renate B Schnabel, Anne Grete Semb, Samuel Sossalla, Sven Wassmann, Patrick Sulzgruber","doi":"10.1093/ehjcvp/pvae042","DOIUrl":"10.1093/ehjcvp/pvae042","url":null,"abstract":"<p><strong>Aims: </strong>Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analysed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety.</p><p><strong>Methods: </strong>We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs vs. VKAs in patients with LVT. Endpoints of interest were stroke or systemic embolism, thrombus resolution, all-cause death, and a composite bleeding endpoint. Estimates were pooled using a random-effects model meta-analysis, and their robustness was investigated using sensitivity and influential analyses.</p><p><strong>Results: </strong>We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3587 patients (2489 VKA vs. 1098 DOAC therapy). The pooled estimates for stroke or systemic embolism [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.57, 1.15] and thrombus resolution (OR: 1.12; 95% CI: 0.86, 1.46) were comparable, and there was low heterogeneity overall across the included studies. The use of DOACs was associated with lower odds of all-cause death (OR: 0.65; 95% CI: 0.46, 0.92) and a composite bleeding endpoint (OR: 0.67; 95% CI: 0.47, 0.97). A risk of bias was evident particularly for observational reports, with some publication bias suggested in funnel plots.</p><p><strong>Conclusion: </strong>In this comprehensive analysis of mainly observational data, the use of DOACs was not associated with a significant difference in stroke or systemic embolism, or thrombus resolution, compared with VKA therapy. The use of DOACs was associated with a lower rate of all-cause death and fewer bleeding events. Adequately sized randomized clinical trials are needed to confirm these findings, which could allow a wider adoption of DOACs in patients with LVT.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"444-453"},"PeriodicalIF":5.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reply to 'Cholinesterase inhibitors are associated with reduced mortality in patients with Alzheimer's disease and previous myocardial infarction'. 对 "胆碱酯酶抑制剂与降低阿尔茨海默病患者和既往心肌梗死患者的死亡率有关 "的答复
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-14 DOI: 10.1093/ehjcvp/pvae023
Bahira Shahim, Hong Xu, Maria Eriksdotter
{"title":"Reply to 'Cholinesterase inhibitors are associated with reduced mortality in patients with Alzheimer's disease and previous myocardial infarction'.","authors":"Bahira Shahim, Hong Xu, Maria Eriksdotter","doi":"10.1093/ehjcvp/pvae023","DOIUrl":"10.1093/ehjcvp/pvae023","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"474-475"},"PeriodicalIF":5.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140329748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
European Heart Journal - Cardiovascular Pharmacotherapy
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