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dc.contributor.authorUeland, Thor
dc.contributor.authorÅkerblom, Axel
dc.contributor.authorGhukasyan, Tatevik
dc.contributor.authorMichelsen, Annika
dc.contributor.authorAukrust, Pål
dc.contributor.authorBecker, Richard C.
dc.contributor.authorBertilsson, Maria
dc.contributor.authorHimmelmann, Anders
dc.contributor.authorJames, Stefan K.
dc.contributor.authorSiegbahn, Agneta
dc.contributor.authorStorey, Robert F.
dc.contributor.authorKontny, Frederic
dc.contributor.authorWallentin, Lars
dc.date.accessioned2018-10-23T08:34:26Z
dc.date.available2018-10-23T08:34:26Z
dc.date.issued2018-01-12
dc.description.abstractBackground: <br>Elevated levels of osteoprotegerin, a secreted tumor necrosis factor–related molecule, might be associated with adverse outcomes in patients with coronary artery disease. We measured plasma osteoprotegerin concentrations on hospital admission, at discharge, and at 1 and 6 months after discharge in a predefined subset (n=5135) of patients with acute coronary syndromes in the PLATO (Platelet Inhibition and Patient Outcomes) trial.<br> Methods and Results:<br>The associations between osteoprotegerin and the composite end point of cardiovascular death, nonprocedural spontaneous myocardial infarction or stroke, and non–coronary artery bypass grafting major bleeding during 1 year of follow-up were assessed by Cox proportional hazards models. Event rates of the composite end point per increasing quartile groups at baseline were 5.2%, 7.5%, 9.2%, and 11.9%. A 50% increase in osteoprotegerin level was associated with a hazard ratio (HR) of 1.31 (95% confidence interval [CI], 1.21–1.42) for the composite end point but was not significant in adjusted analysis (ie, clinical characteristics and levels of C-reactive protein, troponin T, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and growth differentiation factor-15). The corresponding rates of non–coronary artery bypass grafting major bleeding were 2.4%, 2.2%, 3.8%, and 7.2%, with an unadjusted HR of 1.52 (95% CI, 1.36–1.69), and a fully adjusted HR of 1.26 (95% CI, 1.09–1.46). The multivariable association between the osteoprotegerin concentrations and the primary end point after 1 month resulted in an HR of 1.09 (95% CI, 0.89–1.33); for major bleeding after 1 month, the HR was 1.33 (95% CI, 0.91–1.96). <br>Conclusions: <br>In patients with acute coronary syndrome treated with dual antiplatelet therapy, osteoprotegerin was an independent marker of major bleeding but not of ischemic cardiovascular events. Thus, high osteoprotegerin levels may be useful in increasing awareness of increased bleeding risk in patients with acute coronary syndrome receiving antithrombotic therapy.en_US
dc.description.sponsorshipAstraZeneca Boehringer Ingelheim, PlaqueTec Bristol-Myers Squibb Pfizer GlaxoSmithKline Merck & Co Roche Diagnosticsen_US
dc.descriptionSource at: <a href=http://doi.org/10.1161/JAHA.117.007009> http://doi.org/10.1161/JAHA.117.007009</a>en_US
dc.identifier.citationUeland, T., Åkerblom, A., Ghukasyan, T., Michelsen, A., Aukrust, P., Becker, R. C. ... Wallentin, L. (2018). Osteoprotegerin is associated with major bleeding but not with cardiovascular outcomes in patients with acute coronary syndromes: Insights from the PLATO (Platelet Inhibition and Patient Outcomes) trial. Journal of the American Heart Association, 7(2). 10.1161/JAHA.117.007009en_US
dc.identifier.cristinIDFRIDAID 1592726
dc.identifier.doi10.1161/JAHA.117.007009
dc.identifier.issn2047-9980
dc.identifier.urihttps://hdl.handle.net/10037/14011
dc.language.isoengen_US
dc.publisherAmerican Heart Associationen_US
dc.relation.journalJournal of the American Heart Association
dc.rights.accessRightsopenAccessen_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771en_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::General internal medicine: 770en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Generell indremedisin: 770en_US
dc.titleOsteoprotegerin is associated with major bleeding but not with cardiovascular outcomes in patients with acute coronary syndromes: Insights from the PLATO (Platelet Inhibition and Patient Outcomes) trialen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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