| Autor: |
Ryan P. Hickson, Anna M. Kucharska-Newton, Jo E. Rodgers, Betsy L. Sleath, Gang Fang |
| Jazyk: |
angličtina |
| Rok vydání: |
2023 |
| Předmět: |
|
| Zdroj: |
American Heart Journal Plus, Vol 36, Iss , Pp 100339- (2023) |
| Druh dokumentu: |
article |
| ISSN: |
2666-6022 |
| DOI: |
10.1016/j.ahjo.2023.100339 |
| Popis: |
Study objective: Identify optimal P2Y12 inhibitor durations balancing ischemic-benefit and bleeding-risk outcomes after acute myocardial infarction (AMI) in older men and women. Design: Observational retrospective cohort with 2 years of follow-up, using clone-censor-weight marginal structural models to emulate randomization. Setting: 20 % sample of US Medicare administrative claims data. Participants: P2Y12 inhibitor new users ≥66 years old following 2008–2013 AMI hospitalization. Exposures: 12- to 24-month P2Y12 inhibitor durations in 1-month intervals. Main outcome measures: Effectiveness outcome (composite of all-cause mortality, recurrent AMI, ischemic stroke), safety outcome (hospitalized bleed), and negative control outcome (heart failure hospitalization). Results: Of 28,488 P2Y12 inhibitor new users, 51 % were female, 50 % were > 75 years old, 88 % were White/non-Hispanic, and 93 % initiated clopidogrel. Negative control outcome results for 16- through 24-month durations appeared most likely to meet assumptions of no unmeasured confounding. Compared to men taking 24-month therapy, men taking 16-month therapy had higher 2-year risks of the composite effectiveness outcome (relative risk [RR] = 1.08; 95 % confidence interval [95%CI]:1.00–1.15) with similar bleeding risks (RR = 0.98; 95%CI:0.85–1.13). Compared to women taking 24-month therapy, women taking 16-month therapy had similar 2-year risks of the composite effectiveness outcome (RR = 0.98; 95%CI:0.92–1.04) and lower bleeding risks (RR = 0.88; 95%CI:0.80–0.96). Conclusions: Older men taking 24-month P2Y12 inhibitor therapy had the lowest composite effectiveness outcome risk with no increased bleeding risk compared to shorter durations. Women taking 16-month versus 24-month P2Y12 inhibitor therapy had similar composite effectiveness outcome risks but a substantially lower hospitalized bleeding risk, suggesting durations beyond 15–17 months lacked benefit while increasing bleeding risk. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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