Effect of ximelagatran on ischemic events and death in patients with atrial fibrillation after acute myocardial infarction in the efficacy and safety of the oral direct thrombin inhibitor ximelagatran in patients with recent myocardial damage (ESTEEM) trial - 09/08/11
, Lars Frison, PhD a, Douglas Weaver, MD, PhD b, Robbert G. Wilcox, MD, PhD c, Anders Bylock, MD, PhD a, Håkan Emanuelsson, MD, PhD a, Peter Held, MD, PhD a, Jonas Oldgren, MD, PhD dMarco JD Tangelder, Lars Frison, Anders Bylock, Håkan Emanuelsson, and Peter Held are employees of AstraZeneca. Douglas Weaver, Robbert G. Wilcox, and Jonas Oldgren have no conflicts of interest or financial disclosures.
Résumé |
Background |
New-onset trial fibrillation (AF) occurs commonly after acute myocardial infarction (MI) and is associated with a poor prognosis due to stroke or death. The optimal antithrombotic therapy is unknown. The aim of this study was to investigate whether an oral direct thrombin inhibitor, ximelagatran, added to aspirin, reduced the risk of death, myocardial infarction (MI), and stroke in patients who developed AF after their qualifying MI in the efficacy and safety of the oral direct thrombin inhibitor ximelagatran in patients with recent myocardial damage (ESTEEM) trial.
Methods |
The ESTEEM trial evaluated 6 months treatment with ximelagatran together with aspirin, compared to aspirin alone, for prevention of ischemic events in 1883 patients randomized within 14 days after an MI. After their qualifying MI, 174 (9%) patients developed AF in hospital. Multivariate hazard ratios for ximelagatran compared with placebo were calculated by presence AF.
Results |
Of 101 patients with AF treated with ximelagatran 7 (6.9%) had either death, MI, or stroke, compared with 15 (20.6%) in 73 patients allocated to placebo. Ximelagatran reduced the risk of death, MI, or stroke by 70% (hazard ratio 0.30, 95% CI 0.12-0.74). For the separate outcome events, we found similar, nonsignificant trends. One major bleeding event occurred in each treatment group.
Conclusions |
For patients with MI complicated by AF, the combination of aspirin and an oral direct thrombin inhibitor seems beneficial. The high risk for death, MI, and stroke in this population and the increasing use of percutaneous interventions in MI patients may suggest a combination of long-term antiplatelet and anticoagulant therapy. Randomized clinical trials are warranted.
Le texte complet de cet article est disponible en PDF.Abbreviations : AF, CI, MI, PCI, RIKS-HIA, VKA
Plan
Vol 155 - N° 2
P. 382-387 - février 2008 Retour au numéro
Article précédent
- Angina with “normal” coronary arteries: Sex differences in outcomes
- Karin H. Humphries, Aihua Pu, Min Gao, Ronald G. Carere, Louise Pilote
- Causes of death in patients with acute myocardial infarction treated with angiotensin-converting enzyme inhibitors: Findings from the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto (GISSI)–3 trial
- Giovanni Pedrazzini, Eugenio Santoro, Roberto Latini, Laurie Fromm, Maria Grazia Franzosi, Tiziano Mocetti, Lidia Staszewsky, Simona Barlera, Gianni Tognoni, Aldo P. Maggioni, for the GISSI-3 Investigators g
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?