Outcomes in patients after myocardial infarction similar to those of the PEGASUS‐TIMI 54 trial: A cohort study in the French national claims database

Blin, Patrick; Dureau-Pournin, Caroline; Lassalle, R.; Jové, Jérémy; Thomas-Delecourt, Florence; Droz–Perroteau, C.; Danchin, Nicolás; Moore, Nicholas

doi:10.1111/bcp.13291

Cited by 28 publications

(39 citation statements)

References 35 publications

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“…There may be proxies of these, such as chronic obstructive pulmonary disease for smoking, or diabetes for obesity, both associated with negative outcomes post-AMI. 27 While the adjustment performed in the analyses is likely to have allowed us to control for some of the potential biases due to unmeasured confounders, a residual effect cannot be excluded. Like all observational studies, this study cannot pretend to be as free of confounding as a well-conducted randomized controlled clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome: Effectiveness of Treatment Combinations in a Real‐Life Setting

Bezin

Klungel

Lassalle

et al. 2017

Clin Pharma and Therapeutics

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Long-term effectiveness of evidence-based cardiovascular medications (EBCMs) indicated after acute coronary syndrome (ACS) needs to be assessed considering the combination effects for these drugs recommended in association. Using a nationwide database, we conducted a cohort study to evaluate the effectiveness of all possible incomplete EBCMs-based combinations as compared to that associating the four recommended EBCMs over up to 5 years of follow-up. Among the 31,668 patients included, 22.9% had ACS recurrence or died during follow-up. The risks associated with the use of 3-EBCM based combinations were 1.46 (95% confidence interval: 1.33-1.60) for the combinations without statins, 1.30 (1.17-1.43) for the combinations without angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 1.11 (0.98-1.25) for the combinations without antiplatelet agents, and 0.99 (0.89-1.10) for the combination without beta-blockers. These findings question the interest of maintaining long-term treatment with beta-blockers in addition to the other EBCMs for post-ACS secondary prevention.

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Section: Discussionmentioning

confidence: 99%

Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome: Effectiveness of Treatment Combinations in a Real‐Life Setting

Bezin

Klungel

Lassalle

et al. 2017

Clin Pharma and Therapeutics

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“…However, there may be in the databases proxies of these missing information. For instance, we found that long‐term recurrence of MI was mostly associated with diabetes and chronic obstructive pulmonary disease in addition to age . The former is probably a proxy, or at least highly associated with overweight, and probably is the deleterious consequence of overweight.…”

Section: Discussionmentioning

confidence: 84%

“…For instance, we found that long-term recurrence of MI was mostly associated with diabetes and chronic obstructive pulmonary disease in addition to age. 19 The former is probably a proxy, or at least highly associated with overweight, and probably is the deleterious consequence of overweight. The latter is highly correlated with smoking, and again the amount of smoking necessary to cause COPD is similar to that which increases coronary risk.…”

Section: Other (Methodological Research)mentioning

confidence: 99%

The national healthcare system claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology

Bezin

Duong

Lassalle

et al. 2017

Pharmacoepidemiology and Drug

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424

369

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The French health care system is based on universal coverage by one of several health care insurance plans. The SNIIRAM database merges anonymous information of reimbursed claims from all these plans, linked to the national hospital-discharge summaries database system (PMSI) and the national death registry. It now covers 98.8% of the French population, over 66 million persons, from birth (or immigration) to death (or emigration), making it possibly the world's largest continuous homogeneous claims database. The database includes demographic data; health care encounters such as physician or paramedical visits, medicines, medical devices, and lab tests (without results); chronic medical conditions (ICD10 codes); hospitalisations with ICD10 codes for primary, linked and associated diagnoses, date and duration, procedures, diagnostic-related groups, and cost coding; date but currently not cause of death. The power of the database is correlatively great, and its representativeness is near perfect, since it essentially includes the whole country's population. The main difficulty in using the database, beyond its sheer size and complexity, is the administrative process necessary to access it. Recent legislative advances are making this easier. EGB (Echantillon Généraliste de Bénéficiaires) is the 1/97th random permanent representative sample of SNIIRAM, with planned 20-year longitudinal data (10 years at this time). Access time is 1 to 3 months, but its power is less (780 000 subjects). This is enough to study common issues with older drugs but may be limited for new products or rare events.

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“…The unmeasured confounders that could be involved in this case might be smoking and body mass index (BMI). Although we do not have smoking as such we do have proxies of long‐term severe smoking, such as chronic obstructive pulmonary disease (COPD), which is a predictor of repeated coronary events, as well as upper respiratory tract infections (use of antibiotics, ear, nose, and throat consultations), use of smoking cessation aids, or peripheral arterial disease. BMI is also missing but its main consequence, diabetes, is recorded, directly and through the use of antidiabetic drugs and other markers.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness and Safety of Standard or Reduced Dose Dabigatran vs. Rivaroxaban in Nonvalvular Atrial Fibrillation

Blin

Dureau-Pournin

Cottin

et al. 2019

Clin Pharma and Therapeutics

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Dabigatran and rivaroxaban at standard or reduced doses have been compared to warfarin in nonvalvular atrial fibrillation (NVAF), but not to each other. This was a new user study of standard dose and reduced dose dabigatran or rivaroxaban for NVAF in the French healthcare database, matched on gender, age, date of first dispensing, and high-dimensional propensity score, followed 2 years. Hazard ratios (HRs; 95% confidence intervals (CI)) of stroke or systemic embolism (SSE), major bleeding (MB), or death were computed. In matched standard-dose patients (8,290 per arm), mean age 67 years, HRs for dabigatran vs. rivaroxaban were SSE 0.92 (95% CI = 0.67-1.26), MB 0.59 (95% CI = 0.39-0.90), and death 0.84 (95% CI = 0.65-1.11). In reduced-dose patients (7,639 per arm), mean age 80 years, HRs for dabigatran vs. rivaroxaban were SSE 0.73 (95% CI = 0.59-0.94), MB 0.74 (95% CI = 0.57-0.96), and death 0.95 (95% CI = 0.83-1.09). In conclusion, at either dose, dabigatran had similar or better effectiveness than rivaroxaban but lower bleeding risk. Death rates were not different.

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Outcomes in patients after myocardial infarction similar to those of the PEGASUS‐TIMI 54 trial: A cohort study in the French national claims database

Abstract: Patients selected using the criteria described in PEGASUS were older with more comorbidities, resulting in higher all-cause death and bleeding rates, but similar MI recurrence rates.

Cited by 28 publications

References 35 publications

Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome: Effectiveness of Treatment Combinations in a Real‐Life Setting

Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome: Effectiveness of Treatment Combinations in a Real‐Life Setting

The national healthcare system claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology

Comparative Effectiveness and Safety of Standard or Reduced Dose Dabigatran vs. Rivaroxaban in Nonvalvular Atrial Fibrillation

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