TY - JOUR
T1 - Optimal Medical Therapy in Patients with Malignancy Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: a BleeMACS Sub-Study
AU - Iannaccone, Mario
AU - D Ascenzo, Fabrizio
AU - de Filippo, Ovidio
AU - Gagliardi, Marco
AU - Southern, Danielle A.
AU - Raposeiras-Roubín, Sergio
AU - Abu-Assi, Emad
AU - Henriques, Jose Paulo Simao
AU - Saucedo, Jorge
AU - González-Juanatey, José Ramón
AU - Wilton, Stephen B.
AU - Kikkert, Wouter J.
AU - Nuñez-Gil, Iván
AU - Ariza-Sole, Albert
AU - Song, Xiantao
AU - Alexopoulos, Dimitrios
AU - Liebetrau, Christoph
AU - Kawaji, Tetsuma
AU - Huczek, Zenon
AU - Nie, Shao-Ping
AU - Fujii, Toshiharu
AU - Correia, Luis
AU - Kawashiri, Masa-Aki
AU - García-Acuña, José María
AU - Alfonso, Emilio
AU - Terol, Belén
AU - Garay, Alberto
AU - Zhang, Dongfeng
AU - Chen, Yalei
AU - Xanthopoulou, Ioanna
AU - Osman, Neriman
AU - Möllmann, Helge
AU - Shiomi, Hiroki
AU - Kowara, Michal
AU - Filipiak, Krzysztof
AU - Wang, Xiao
AU - Yan, Yan
AU - Fan, Jing-Yao
AU - Ikari, Yuji
AU - Nakahashi, Takuya
AU - Sakata, Kenji
AU - Yamagishi, Masakazu
AU - Moretti, Claudio
AU - Gaita, Fiorenzo
AU - Kalpak, Oliver
AU - Kedev, Sasko
PY - 2017
Y1 - 2017
N2 - Objective Our objective was to define the most appropriate treatment for acute coronary syndrome (ACS) in patients with malignancy. Methods and Results The BleeMACS project is a worldwide multicenter observational prospective registry in 16 hospitals enrolling patients with ACS undergoing percutaneous coronary intervention. Primary endpoints were death, re-infarction, and major adverse cardiac events (MACE; composite of death and re-infarction) after 1 year of follow-up. The secondary endpoint was bleeding events during follow-up. We performed sub-study analyses according to whether beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, or proton pump inhibitors (PPIs) were prescribed at discharge. We also calculated the propensity score for optimal medical therapy (OMT; combination of BB, ACEI/ARB, and statins). The study included 926 patients. According to the multivariate analysis, ACEIs/ARBs (hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36-1.94; p = 0.03) and statins (HR 0.37, 95 % CI 0.23-0.61; p <0.01) reduced the risk of MACE, while the effects of BBs (HR 0.85, 95 % CI 0.55-1.32; p = 0.48) and PPIs (HR 1.33, 95 % CI 0.83-2.12; p = 0.23) were not significant. OMT was prescribed at discharge in 300 (32.4 %) patients; after propensity score analysis, OMT showed a significant reduction in death (3 % vs. 12.5 %, HR 0.21, 95 % CI 0.1-0.4; log-rank p <0.001) and MACE (6.7 vs. 15.2 %, log-rank p = 0.01). Conclusion In patients with ACS and malignancy, OMT reduces the risk of adverse events at 1 year; in particular, ACEIs/ARBs and statins were the most protective drugs.
AB - Objective Our objective was to define the most appropriate treatment for acute coronary syndrome (ACS) in patients with malignancy. Methods and Results The BleeMACS project is a worldwide multicenter observational prospective registry in 16 hospitals enrolling patients with ACS undergoing percutaneous coronary intervention. Primary endpoints were death, re-infarction, and major adverse cardiac events (MACE; composite of death and re-infarction) after 1 year of follow-up. The secondary endpoint was bleeding events during follow-up. We performed sub-study analyses according to whether beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, or proton pump inhibitors (PPIs) were prescribed at discharge. We also calculated the propensity score for optimal medical therapy (OMT; combination of BB, ACEI/ARB, and statins). The study included 926 patients. According to the multivariate analysis, ACEIs/ARBs (hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36-1.94; p = 0.03) and statins (HR 0.37, 95 % CI 0.23-0.61; p <0.01) reduced the risk of MACE, while the effects of BBs (HR 0.85, 95 % CI 0.55-1.32; p = 0.48) and PPIs (HR 1.33, 95 % CI 0.83-2.12; p = 0.23) were not significant. OMT was prescribed at discharge in 300 (32.4 %) patients; after propensity score analysis, OMT showed a significant reduction in death (3 % vs. 12.5 %, HR 0.21, 95 % CI 0.1-0.4; log-rank p <0.001) and MACE (6.7 vs. 15.2 %, log-rank p = 0.01). Conclusion In patients with ACS and malignancy, OMT reduces the risk of adverse events at 1 year; in particular, ACEIs/ARBs and statins were the most protective drugs.
U2 - https://doi.org/10.1007/s40256-016-0196-x
DO - https://doi.org/10.1007/s40256-016-0196-x
M3 - Article
C2 - 27738920
SN - 1175-3277
VL - 17
SP - 61
EP - 71
JO - American journal of cardiovascular drugs
JF - American journal of cardiovascular drugs
IS - 1
ER -