Key result
Cirrhosis linked to ~49% higher 1-year mortality risk in AMI patients on DAPT.
Why the study?
Patients with cirrhosis and acute myocardial infarction present a clinical dilemma regarding the use of dual antiplatelet therapy.
Does dual antiplatelet therapy affect outcomes differently in patients with acute myocardial infarction and cirrhosis compared to those without cirrhosis?
Cohort (n=4,570)
Does dual antiplatelet therapy affect outcomes differently in patients with acute myocardial infarction and cirrhosis compared to those without cirrhosis?
In patients with acute myocardial infarction on dual antiplatelet therapy, concurrent cirrhosis is associated with a lower risk of recurrent MI but higher risks of mortality and gastrointestinal bleeding compared to those without cirrhosis.
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DAPT in cirrhosis with AMI was associated with fewer recurrent MIs but higher mortality and GI bleeding; leaves open optimal strategy pending randomized data.
BACKGROUND: Patients with cirrhosis and acute myocardial infarction (AMI) present dilemma whether dual antiplatelet therapy (DAPT) should be used. METHODS: Electronic medical records between 2001-2013 were retrieved from Taiwan National Health Insurance Research Database. Patients were excluded for missing information, age <20 years old, history of AMI, liver transplant, autoimmune disease, coagulopathy, taking DAPT 3 months before index date, follow-up <3 months, anticoagulation user, without DAPT, and events of myocardial infarction (MI), ischemic stroke, major bleeding, and heart failure within 3-month of enrollment. Primary outcomes were 1-year all-cause mortality, recurrent MI, major bleeding, and gastrointestinal bleeding. RESULTS: A total of 150,887 patients with AMI retrieved. After exclusion criteria and propensity score-matching, 914 cirrhotic and 3,656 non-cirrhotic patients with AMI on DAPT were studied. During 1-year follow-up, there was significantly increased mortality in cirrhotic patients compared to non-cirrhotic patients (HR = 1.49, 95% CI = 1.28-1.74). There was significantly decreased recurrent MI in cirrhotic patients compared to non-cirrhotic patients (subdistribution HR [SHR] = 0.71, 95% CI = 0.54-0.92). However, non-significantly increased major bleeding (SHR = 1.23, 95% CI = 0.87-1.73) and significantly increased gastrointestinal bleeding (SHR = 1.49, 95% CI = 1.31-1.70). CONCLUSIONS: In cirrhotic patients with AMI, DAPT offers benefit with decreased recurrent MI at the expense of increased gastrointestinal bleeding.
Wu et al. (2019) conducted a cohort in Cirrhosis and acute myocardial infarction (n=4,570). Cirrhosis vs. Non-cirrhosis was evaluated on 1-year all-cause mortality (HR 1.49, 95% CI 1.28-1.74). In patients with acute myocardial infarction on dual antiplatelet therapy, cirrhosis was associated with a significantly increased risk of 1-year all-cause mortality compared to non-cirrhotic patients (HR 1.49).
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