title: Prevalence and Prognosis of High-risk Myocardial Infarction Patient Candidates to Extended Antiplatelet Therapy.
abstract: OBJECTIVE
  Secondary prevention in myocardial infarction patients is paramount to prevent recurrences. Dual antiplatelet therapy has been shown to reduce the risk of subsequent events up to 1 year and beyond in the PEGASUS-TIMI 54 trial. This study aimed to estimate the annual number of myocardial infarction patients with PEGASUS characteristics in Spain and to analyze short- and long-term outcomes in these patients.
  
  
  METHODS
  The number of myocardial infarction patients was estimated assuming a Poisson distribution. Myocardial infarction incidence and mortality rates obtained from population registries (IBERICA and REGICOR) were properly adjusted. The proportion of myocardial infarction patients with PEGASUS characteristics was estimated with a REGICOR cohort of consecutive patients from 2003-2009 (n=1391). This cohort follow-up was used to compare the occurrence of reinfarction and death at 1 year and at the end of the follow-up (4.7 years) in patients with and without PEGASUS characteristics by Cox regression.
  
  
  RESULTS
  The estimated annual number of stable myocardial infarction patients aged ≥ 50 years and without bleeding events was 41 311. Of these, 22 493 had at least 1 PEGASUS characteristic (diabetes, previous myocardial infarction, or chronic kidney disease). At 4.7 years of follow-up, having any PEGASUS characteristic or age ≥ 65 years was associated with a higher risk of cardiovascular and all-cause death in adjusted analyses (hazard ratio=3.44 and 2.21, 95% confidence interval, 1.22-9.74 and 1.11-4.42, respectively).
  
  
  CONCLUSIONS
  In Spain, more than 50% of the stable myocardial infarction patients aged ≥ 50 years are estimated to have at least 1 PEGASUS characteristic, which substantially increases the long-term risk of cardiovascular and all-cause death.
authors.affiliation: Grupo de Investigación en Epidemiología y Genética Cardiovascular, Programa de Epidemiología y Salud Pública, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
authors.affiliation: Grupo de Investigación en Epidemiología y Genética Cardiovascular, Programa de Epidemiología y Salud Pública, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
authors.affiliation: Grupo de Investigación en Epidemiología y Genética Cardiovascular, Programa de Epidemiología y Salud Pública, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Grau
authors.affiliation: Grupo de Investigación en Epidemiología y Genética Cardiovascular, Programa de Epidemiología y Salud Pública, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Sayols-Baixeras
authors.affiliation: Grupo de Investigación en Epidemiología y Genética Cardiovascular, Programa de Epidemiología y Salud Pública, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain. Electronic address: iroman@imim.es.
authors.forename: Irene R
authors.initials: IR
authors.lastname: Dégano
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D003920:Diabetes Mellitus; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic; D018570:Risk Assessment; D055502:Secondary Prevention; D013030:Spain / Q000453:epidemiology; D000077486:Ticagrelor; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077486:Ticagrelor; D000241:Adenosine; D001241:Aspirin
keywords: Coronary disease; Diabetes mellitus; Enfermedad coronaria; Epidemiology; Epidemiología; Estudios de seguimiento; Follow-up studies; Infarto de miocardio; Myocardial infarction; Prognosis; Pronóstico; Supervivencia; Survival