Major bleeding and the ADP-binding enzyme creatine kinase in non-ST-segment elevation acute coronary syndromes

Collet, Jean‐Philippe; Thiele, Holger

doi:10.1093/eurheartj/ehaa908

European Heart Journal

2020

DOI: 10.1093/eurheartj/ehaa908

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Major bleeding and the ADP-binding enzyme creatine kinase in non-ST-segment elevation acute coronary syndromes

Jean‐Philippe Collet

Holger Thiele

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“…[1][2][3] Despite effective pharmacotherapy for secondary prevention, the incidence of recurrent ischemic events is still high. 4,5 Patient adherence to secondary prevention medications has been estimated to be approximately 50%, 6,7 a lack of adherence that has been associated with poorer outcomes. 8 Barriers to adherence include factors related to the characteristics of patients, their prescribers, and their health care systems.…”

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confidence: 99%

Polypill Strategy in Secondary Cardiovascular Prevention

2022

N Engl J Med

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BACKGROUNDA polypill that includes key medications associated with improved outcomes (aspirin, angiotensin-converting-enzyme [ACE] inhibitor, and statin) has been proposed as a simple approach to the secondary prevention of cardiovascular death and complications after myocardial infarction. METHODSIn this phase 3, randomized, controlled clinical trial, we assigned patients with myocardial infarction within the previous 6 months to a polypill-based strategy or usual care. The polypill treatment consisted of aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and atorvastatin (20 or 40 mg). The primary composite outcome was cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization. The key secondary end point was a composite of cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke. RESULTSA total of 2499 patients underwent randomization and were followed for a median of 36 months. A primary-outcome event occurred in 118 of 1237 patients (9.5%) in the polypill group and in 156 of 1229 (12.7%) in the usual-care group (hazard ratio, 0.76; 95% confidence interval [CI], 0.60 to 0.96; P = 0.02). A key secondaryoutcome event occurred in 101 patients (8.2%) in the polypill group and in 144 (11.7%) in the usual-care group (hazard ratio, 0.70; 95% CI, 0.54 to 0.90; P = 0.005). The results were consistent across prespecified subgroups. Medication adherence as reported by the patients was higher in the polypill group than in the usual-care group. Adverse events were similar between groups. CONCLUSIONSTreatment with a polypill containing aspirin, ramipril, and atorvastatin within 6 months after myocardial infarction resulted in a significantly lower risk of major adverse cardiovascular events than usual care. (Funded by the European Union Horizon 2020; SECURE ClinicalTrials.gov number, NCT02596126; EudraCT number, 2015 -002868 -17.

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confidence: 99%

Polypill Strategy in Secondary Cardiovascular Prevention

2022

N Engl J Med

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Challenges of antithrombotic treatment in high-risk populations and a fond farewell to CKMB

Crea

2021

European Heart Journal

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Major bleeding and the ADP-binding enzyme creatine kinase in non-ST-segment elevation acute coronary syndromes

Cited by 2 publications

References 4 publications

Polypill Strategy in Secondary Cardiovascular Prevention

Polypill Strategy in Secondary Cardiovascular Prevention

Challenges of antithrombotic treatment in high-risk populations and a fond farewell to CKMB

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