Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

Nikolai Juul; Gunnar Gislason; Jonas Bjerring Olesen; Morten Lamberts; Morten Lock Hansen; Deniz Karasoy; Christine Benn Christiansen; Christian Torp-Pedersen; Rikke Sorensen

doi:10.1177/2048872614538848

Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

Nikolai Juul, Gunnar Gislason, Jonas Bjerring Olesen, Morten Lamberts, Morten Lock Hansen, Deniz Karasoy, Christine Benn Christiansen, Christian Torp-Pedersen, Rikke Sorensen

Department of Clinical Medicine

Abstract

BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization.

METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population.

RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (<60 years), 76% (60-69 years), 66% (70-79 years) and 52% (>79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users <60 years (Hazard ratio (HR) =0.69; 95% confidence interval (CI) 0.59-0.80), 60-69 years (HR=0.64; 95% CI 0.56-0.73), 70-79 years (HR=0.80; 95% CI 0.72-0.89) and >79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged <60 years (HR=1.63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population.

CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

Original language	English
Journal	European Heart Journal: Acute Cardiovascular Care
Volume	6
Issue number	6
Pages (from-to)	511-521
Number of pages	11
ISSN	2048-8726
DOIs	https://doi.org/10.1177/2048872614538848
Publication status	Published - 1 Sept 2017

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10.1177/2048872614538848

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Juul, N., Gislason, G., Olesen, J. B., Lamberts, M., Hansen, M. L., Karasoy, D., Christiansen, C. B., Torp-Pedersen, C., & Sorensen, R. (2017). Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups. European Heart Journal: Acute Cardiovascular Care, 6(6), 511-521. https://doi.org/10.1177/2048872614538848

Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups. / Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring et al.

In: European Heart Journal: Acute Cardiovascular Care, Vol. 6, No. 6, 01.09.2017, p. 511-521.

Research output: Contribution to journal › Journal article › Research › peer-review

Juul, N, Gislason, G, Olesen, JB, Lamberts, M, Hansen, ML, Karasoy, D, Christiansen, CB, Torp-Pedersen, C & Sorensen, R 2017, 'Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups', European Heart Journal: Acute Cardiovascular Care, vol. 6, no. 6, pp. 511-521. https://doi.org/10.1177/2048872614538848

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title = "Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups",

abstract = "BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization.METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population.RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (<60 years), 76% (60-69 years), 66% (70-79 years) and 52% (>79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users <60 years (Hazard ratio (HR) =0.69; 95% confidence interval (CI) 0.59-0.80), 60-69 years (HR=0.64; 95% CI 0.56-0.73), 70-79 years (HR=0.80; 95% CI 0.72-0.89) and >79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged <60 years (HR=1.63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population.CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.",

author = "Nikolai Juul and Gunnar Gislason and Olesen, {Jonas Bjerring} and Morten Lamberts and Hansen, {Morten Lock} and Deniz Karasoy and Christiansen, {Christine Benn} and Christian Torp-Pedersen and Rikke Sorensen",

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doi = "10.1177/2048872614538848",

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T1 - Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

AU - Juul, Nikolai

AU - Gislason, Gunnar

AU - Olesen, Jonas Bjerring

AU - Lamberts, Morten

AU - Hansen, Morten Lock

AU - Karasoy, Deniz

AU - Christiansen, Christine Benn

AU - Torp-Pedersen, Christian

AU - Sorensen, Rikke

PY - 2017/9/1

Y1 - 2017/9/1

N2 - BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization.METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population.RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (<60 years), 76% (60-69 years), 66% (70-79 years) and 52% (>79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users <60 years (Hazard ratio (HR) =0.69; 95% confidence interval (CI) 0.59-0.80), 60-69 years (HR=0.64; 95% CI 0.56-0.73), 70-79 years (HR=0.80; 95% CI 0.72-0.89) and >79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged <60 years (HR=1.63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population.CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

AB - BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization.METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population.RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (<60 years), 76% (60-69 years), 66% (70-79 years) and 52% (>79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users <60 years (Hazard ratio (HR) =0.69; 95% confidence interval (CI) 0.59-0.80), 60-69 years (HR=0.64; 95% CI 0.56-0.73), 70-79 years (HR=0.80; 95% CI 0.72-0.89) and >79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged <60 years (HR=1.63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population.CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

U2 - 10.1177/2048872614538848

DO - 10.1177/2048872614538848

M3 - Journal article

C2 - 24936092

SN - 2048-8726

VL - 6

SP - 511

EP - 521

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

IS - 6

ER -

Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

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