{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T04:52:53Z","timestamp":1788065573217,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,9,22]]},"abstract":"\n Background<\/jats:title>\n \n Understanding the relative risk of cardiovascular versus noncardiovascular death is important for designing clinical trials. These risks may differ depending on patient age, sex, and type of acute coronary syndrome (\n ACS<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n IMPROVE<\/jats:styled-content>\n \u2010\n IT<\/jats:styled-content>\n (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) was a randomized controlled trial of simvastatin plus either ezetimibe or placebo following stabilized\n ACS<\/jats:styled-content>\n . Cause of death was adjudicated by an independent committee. We compared the cumulative incidence of cardiovascular and noncardiovascular death for patients with unstable angina\/non\u2010\n ST<\/jats:styled-content>\n \u2010segment elevation myocardial infarction (\n UA<\/jats:styled-content>\n \/\n NSTEMI<\/jats:styled-content>\n ) and\n ST<\/jats:styled-content>\n \u2010segment elevation myocardial infarction (\n STEMI<\/jats:styled-content>\n ), in those <65 and \u226565\u00a0years old, and males and females, over 7\u00a0years of follow\u2010up. Of 18\u00a0131 patients, the presenting event was\n STEMI<\/jats:styled-content>\n for 5190 (29%) and\n UA<\/jats:styled-content>\n \/\n NSTEMI<\/jats:styled-content>\n for 12\u00a0941 (71%); 10\u00a0173 (56%) patients were <65 years old and 7971 (44%) were \u226565\u00a0years old at presentation.\n UA<\/jats:styled-content>\n \/\n NSTEMI<\/jats:styled-content>\n patients were older than\n STEMI<\/jats:styled-content>\n patients, with more cardiovascular and noncardiovascular risk factors. In\n STEMI<\/jats:styled-content>\n patients, the cumulative incidence of cardiovascular death was higher for \u223c4\u00a0years following the index event, after which noncardiovascular death predominated. In\n UA<\/jats:styled-content>\n \/\n NSTEMI<\/jats:styled-content>\n patients, the cumulative incidence of cardiovascular death remained higher than noncardiovascular death over the full follow\u2010up period. Patients \u226565 years old and <65\u00a0years old had a higher incidence of cardiovascular death than noncardiovascular death over the entirety of follow\u2010up. Female patients had a higher incidence of cardiovascular death than noncardiovascular death for \u223c6\u00a0years following the index event; male patients had a higher incidence of cardiovascular death than noncardiovascular death over the entirety of follow\u2010up.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Among post\u2010\n ACS<\/jats:styled-content>\n patients enrolled in a long\u2010term clinical trial, the relative incidence of cardiovascular and noncardiovascular death differed based on type of\n ACS<\/jats:styled-content>\n presentation and sex, but not age. These findings further delineate long\u2010term prognosis after\n ACS<\/jats:styled-content>\n and should inform the design of future cardiovascular outcomes trials.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.005840","type":"journal-article","created":{"date-parts":[[2017,9,19]],"date-time":"2017-09-19T00:20:13Z","timestamp":1505780413000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Competing Risks of Cardiovascular Versus Noncardiovascular Death During Long\u2010Term Follow\u2010Up After Acute Coronary Syndromes"],"prefix":"10.1161","volume":"6","author":[{"given":"Alexander C.","family":"Fanaroff","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC"},{"name":"Division of Cardiology, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Roe","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC"},{"name":"Division of Cardiology, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Clare","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliya","family":"Lokhnygina","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Marie","family":"Navar","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC"},{"name":"Division of Cardiology, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert P.","family":"Giugliano","sequence":"additional","affiliation":[{"name":"Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D.","family":"Wiviott","sequence":"additional","affiliation":[{"name":"Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Tershakovec","sequence":"additional","affiliation":[{"name":"Merck & Co. 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