Pasea, L, Chung, S-C, Pujades-Rodriguez, M et al. (9 more authors) (2017) Personalising the decision for prolonged dual antiplatelet therapy: Development, validation and potential impact of prognostic models for cardiovascular events and bleeding in myocardial infarction survivors. European Heart Journal, 38 (14). pp. 1048-1055. ISSN 0195-668X
Abstract
Aims: To develop models to aid the decision to prolong dual antiplatelet therapy (DAPT) requires balancing an individual patient’s potential benefits and harms. Methods and results: Using population-based electronic health records (CALIBER, England, 2000-2010), of patients evaluated 1 year after acute MI we developed (n=12,694 patients) and validated (n=5,613) prognostic models for cardiovascular (cardiovascular death, MI or stroke) and three different bleeding endpoints. We applied trial effect estimates to determine potential benefits and harms of DAPT and individuals net clinical benefit. Prognostic models for cardiovascular events (c-index: 0.75 (95% CI: 0.74, 0.77)) and bleeding (c index 0.72 (95% CI: 0.67, 0.77)) were well calibrated: 3-year risk of cardiovascular events was 16.5% overall (5.2% in lowest and 46.7% in highest-risk individuals) while for major bleeding it was 1.7% (0.3% in lowest and 5.4% in highest-risk patients). For every 10,000 patients treated per year, we estimated 249 (95% CI: 228, 269) cardiovascular events prevented and 134 (95% CI: 87,181) major bleeding events caused in highest-risk patients, and 28 (95% CI: 19, 37) cardiovascular events prevented and 9 (95% CI: 0, 20) major bleeding events caused in lowest-risk patients. There was a net clinical benefit of prolonged DAPT in 63% to 99% patients depending on how benefits and harms were weighted. Conclusions: Prognostic models for cardiovascular events and bleeding using population-based electronic health records may help personalise decisions for prolonged DAPT 1 year following acute MI.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author 2017. Published on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | Prognosis; Myocardial infarction; Bleeding |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Molecular Medicine (LIMM) (Leeds) > Section of Translational Medicine (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 20 Dec 2016 11:43 |
Last Modified: | 05 Oct 2017 16:25 |
Published Version: | https://doi.org/10.1093/eurheartj/ehw683 |
Status: | Published |
Publisher: | Oxford University Press |
Identification Number: | 10.1093/eurheartj/ehw683 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:109705 |