The browser you are using is not supported by this website. All versions of Internet Explorer are no longer supported, either by us or Microsoft (read more here: https://www.microsoft.com/en-us/microsoft-365/windows/end-of-ie-support).

Please use a modern browser to fully experience our website, such as the newest versions of Edge, Chrome, Firefox or Safari etc.

Gustav Smith, MD, PhD

Gustav Smith

Associate professor

Gustav Smith, MD, PhD

Outcomes associated with dual antiplatelet therapy after myocardial infarction in patients with aortic stenosis

Author

  • Andreas Martinsson
  • Xinjun Li
  • Christian Torp-Pedersen
  • Bengt Zöller
  • Pontus Andell
  • Charlotte Andreasen
  • Gunnar Gislason
  • Lars Køber
  • Kristina Sundquist
  • J. Gustav Smith
  • Charlotte Andersson
Show all

Summary, in English

Background: Acquired loss of the largest von Willebrand factor multimers is a common hemostatic disturbance in patients with aortic valve stenosis (AS), resulting in impaired platelet adhesion and increased bleeding risk. AS is also associated with atherosclerosis and myocardial infarction (MI). Our aim was to study the clinical outcomes associated with AS in MI patients treated with dual antiplatelet therapy (DAPT) in a nationwide hospital-based register study. Methods: Based on nationwide hospital discharge registers from Sweden (2005–2010) and Denmark (2005–2015), we calculated 1-year incidence rates and hazard ratios of bleeding, recurrent MI, and all-cause mortality in MI patients with and without AS treated with DAPT. Results from both countries were also combined in a meta-analysis. Results: We included 50,460 MI patients from Sweden and 50,307 MI patients from Denmark, of which 3% had AS. The bleeding rates (per 100 person-years) in Sweden and Denmark were 3.2 and 3.3 among patients without AS vs. 9.2 and 8.3 among patients with AS. All-cause mortality rates were 7.1 vs. 28.7 in Sweden and 5.8 vs. 30.7 in Denmark among patients without and with AS, respectively. Patients with AS had an increased risk of bleeding, recurrent MI and all-cause mortality. Combined results from both countries were similar for bleeding (hazard ratio 1.59 [0.98–2.59]), recurrent MI (1.78 [1.25–2.54]), and all-cause mortality (1.76 [1.26–2.47]). Conclusion: AS was associated with an increased risk of bleeding, recurrent MI and mortality after MI when treated with DAPT. Individualized selection of antiplatelet therapy may be warranted in this high-risk population.

Department/s

  • Molecular Epidemiology and Cardiology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Family Medicine, Cardiovascular Epidemiology and Lifestyle
  • Family Medicine and Clinical Epidemiology
  • EpiHealth: Epidemiology for Health
  • Cardiology

Publishing year

2019

Language

English

Publication/Series

International Journal of Cardiology

Document type

Journal article

Publisher

Elsevier

Topic

  • Cardiac and Cardiovascular Systems

Keywords

  • Aortic stenosis
  • Dual anti-platelet therapy
  • Epidemiology
  • Myocardial infarction

Status

Published

Research group

  • Molecular Epidemiology and Cardiology
  • Family Medicine, Cardiovascular Epidemiology and Lifestyle
  • Family Medicine and Clinical Epidemiology

ISBN/ISSN/Other

  • ISSN: 0167-5273