Document Detail

Prognostic modeling of individual patient risk and mortality impact of ischemic and hemorrhagic complications: assessment from the Acute Catheterization and Urgent Intervention Triage Strategy trial.
MedLine Citation:
PMID:  20026777     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Both ischemic and hemorrhagic complications increase mortality rate in acute coronary syndromes. Their frequency and relative importance vary according to individual patient risk profiles. We sought to develop prognostic models for the risk of myocardial infarction (MI) and major bleeding to assess their impact on risk of death and to examine the manner in which alternative antithrombotic regimens affect these risks in individual patients. METHODS AND RESULTS: The Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial randomized 13 819 patients with acute coronary syndrome to heparin plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin alone. By logistic regression, there were 5 independent predictors of MI within 30 days (n=705; 5.1%) and 8 independent predictors of major bleeding (n=645; 4.7%), only 2 of which were common to both event types. In a covariate-adjusted, time-updated Cox regression model, both MI and major bleeding significantly affected subsequent mortality rate (hazard ratios, 2.7 and 2.9, respectively; both P<0.001). Treatment with bivalirudin versus heparin plus a glycoprotein IIb/IIIa inhibitor was associated with a nonsignificant 8% increase in MI and a highly significant 50% decrease in major bleeding. Given the individual patient risk profiles and the fact that bivalirudin prevented approximately 6 major bleeds for each MI that might occur from its use, the estimated reduction in bleeding was greater than the estimated increase in MI by bivalirudin alone rather than heparin plus a glycoprotein IIb/IIIa inhibitor for nearly all patients. CONCLUSIONS: Consideration of the individual patient risk profile for MI and major bleeding and the relative treatment effects of alternative pharmacotherapies permits personalized decision making to optimize therapy of patients with acute coronary syndrome. CLINICAL TRIAL REGISTRATION: Identifier: NCT00093158.
Stuart J Pocock; Roxana Mehran; Tim C Clayton; Eugenia Nikolsky; Helen Parise; Martin Fahy; Alexandra J Lansky; Michel E Bertrand; A Michael Lincoff; Jeffrey W Moses; E Magnus Ohman; Harvey D White; Gregg W Stone
Related Documents :
11428477 - A meta-analysis of controlled clinical trials comparing low-molecular weight heparins w...
20673167 - Treatment patterns in patients with acute coronary syndrome undergoing percutaneous cor...
10724797 - Abciximab. a pharmacoeconomic review of its use in percutaneous coronary revascularisat...
1455187 - Gastric changes in coronary-operated patients with low-dose aspirin.
24668517 - Clinical correlates of echocardiographic tissue velocity imaging abnormalities of the l...
1130287 - Abnormal segmental contraction velocity in coronary artery disease produced by isometri...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-21
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-05     Completed Date:  2010-01-28     Revised Date:  2010-09-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  43-51     Citation Subset:  AIM; IM    
Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Data Bank Information
Bank Name/Acc. No.:
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Acute Coronary Syndrome / drug therapy,  mortality
Aged, 80 and over
Fibrinolytic Agents / adverse effects*
Hemorrhage / chemically induced*,  mortality*
Heparin / adverse effects
Hirudins / adverse effects
Logistic Models
Middle Aged
Multivariate Analysis
Myocardial Infarction / mortality
Myocardial Ischemia / drug therapy*,  mortality*
Peptide Fragments / adverse effects
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Predictive Value of Tests
Randomized Controlled Trials as Topic / statistics & numerical data
Recombinant Proteins / adverse effects
Retrospective Studies
Risk Factors
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin
Comment In:
Circulation. 2010 Sep 21;122(12):e461; author reply e462-3   [PMID:  20855666 ]
Circulation. 2010 Jan 5;121(1):5-7   [PMID:  20026787 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Myocardial ischemia/reperfusion injury is mediated by leukocytic toll-like receptor-2 and reduced by...
Next Document:  Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction a...