REMO HOLANDA DE MENDONCA FURTADO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 3 Citação(ões) na Scopus
    Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial
    (2019) NICOLAU, Jose C.; STEVENS, Susanna R.; AL-KHALIDI, Hussein R.; JATENE, Fabio B.; FURTADO, Remo H. M.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; DESVIGNE-NICKENS, Patrice; HADDAD, Haissam; JOLICOEUR, E. Marc; PETRIE, Mark C.; DOENST, Torsten; MICHLER, Robert E.; OHMAN, E. Magnus; MADDURY, Jyotsna; ALI, Imtiaz; DEJA, Marek A.; ROULEAU, Jean L.; VELAZQUEZ, Eric J.; HILL, James A.
    Background: The STICH trial showed superiority of coronary artery bypass plus medical treatment (CABG) over medical treatment alone (MED) in patients with left ventricular ejection fraction (LVEF) <= 35%. In previous publications, percutaneous coronary intervention (PCI) prior to CABG was associated with worse prognosis. Objectives: The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. Methods and results: Patients in the STICH trial (n=1212), followed for a median time of 9.8 years, were included in the present analyses. In the total population, 156 had a prior PCI (74 and 82, respectively, in the MED and CABG groups). In those with vs. without prior PCI, the adjusted hazard-ratios (aHRs) were 0.92 (95% CI=0.74-1.15) for all-cause mortality, 0.85 (95% CI=0.64-1.11) for CV mortality, and 1.43 (95% CI=1.15-1.77) for CV hospitalization. In the group randomized to CABG without prior PCI, the aHRs were 0.82 (95% CI=0.70-0.95) for all-cause mortality, 0.75 (95% CI=0.62-0.90) for CV mortality and 0.67 (95% CI=0.56-0.80) for CV hospitalization. In the group randomized to CABG with prior PCI, the aHRs were 0.76 (95% CI=0.50-1.15) for all-cause mortality, 0.81 (95% CI=0.49-1.36) for CV mortality and 0.61 (95% CI=0.41-0.90) for CV hospitalization. There was no evidence of interaction between randomized treatment and prior PCI for any endpoint (all adjusted p > 0.05). Conclusion: In the STICH trial, prior PCI did not affect the outcomes of patients whether they were treated medically or surgically, and the superiority of CABG over MED remained unchanged regardless of prior PCI.
  • article 6 Citação(ões) na Scopus
    Relation of High Lipoprotein (a) Concentrations to Platelet Reactivity in Individuals with and Without Coronary Artery Disease
    (2020) SALSOSO, Rocio; DALCOQUIO, Talia F.; FURTADO, Remo H. M.; FRANCI, Andre; BARBOSA, Carlos J. D. G.; GENESTRETI, Paulo R. R.; STRUNZ, Celia M. C.; LIMA, Viviane; BARACIOLI, Luciano M.; GIUGLIANO, Robert P.; GOODMAN, Shaun G.; GURBEL, Paul A.; MARANHAO, Raul C.; NICOLAU, Jose C.
    Introduction Lipoprotein (a) [Lp(a)] is a risk factor for coronary artery disease (CAD). To the best of our knowledge, this is the first study addressing the relationship between Lp(a) and platelet reactivity in primary and secondary prevention. Methods Lp(a) was evaluated in 396 individuals with (82.3%) and without (17.7%) obstructive CAD. The population was divided into two groups according to Lp(a) concentrations with a cutoff value of 50 mg/dL. The primary objective was to evaluate the association between Lp(a) and adenosine diphosphate (ADP)-induced platelet reactivity using the VerifyNow (TM) P2Y(12)assay. Platelet reactivity was also induced by arachidonic acid and collagen-epinephrine (C-EPI) and assessed by Multiplate (TM), platelet function analyzer (TM) 100 (PFA-100), and light transmission aggregometry (LTA) assays. Secondary objectives included the assessment of the primary endpoint in individuals with or without CAD. Results Overall, 294 (74.2%) individuals had Lp(a) < 50 mg/dL [median (IQR) 13.2 (5.8-27.9) mg/dL] and 102 (25.8%) had Lp(a) >= 50 mg/dL [82.5 (67.6-114.5) mg/dL],P < 0.001. Univariate analysis in the entire population revealed no differences in ADP-induced platelet reactivity between individuals with Lp(a) >= 50 mg/dL (249.4 +/- 43.8 PRU) versus Lp(a) < 50 mg/dL (243.1 +/- 52.2 PRU),P = 0.277. Similar findings were present in individuals with (P = 0.228) and without (P = 0.669) CAD, and regardless of the agonist used or method of analysis (allP > 0.05). Finally, multivariable analysis did not show a significant association between ADP-induced platelet reactivity and Lp(a) >= 50 mg/dL [adjusted OR = 1.00 [(95% CI 0.99-1.01),P = 0.590]. Conclusion In individuals with or without CAD, Lp(a) >= 50 mg/dL was not associated with higher platelet reactivity.
  • article 237 Citação(ões) na Scopus
    Effect of Dapagliflozin on Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus Insights From the DECLARE-TIMI 58 Trial
    (2020) ZELNIKER, Thomas A.; BONACA, Marc P.; FURTADO, Remo H. M.; MOSENZON, Ofri; KUDER, Julia F.; MURPHY, Sabina A.; BHATT, Deepak L.; LEITER, Lawrence A.; MCGUIRE, Darren K.; WILDING, John P. H.; BUDAJ, Andrzej; KISS, Robert G.; PADILLA, Francisco; GAUSE-NILSSON, Ingrid; LANGKILDE, Anna Maria; RAZ, Itamar; SABATINE, Marc S.; WIVIOTT, Stephen D.
    Background: Atrial fibrillation (AF) and atrial flutter (AFL) are associated with both diabetes mellitus and its related comorbidities, including hypertension, obesity, and heart failure (HF). SGLT2 (sodium-glucose cotransporter 2) inhibitors have been shown to lower blood pressure, reduce weight, have salutary effects on left ventricular remodeling, and reduce hospitalization for HF and cardiovascular death in patients with type 2 diabetes mellitus. We therefore investigated whether SGLT2 inhibitors could also reduce the risk of AF/AFL. Methods: DECLARE-TIMI 58 (Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58) studied the efficacy and safety of the SGLT2 inhibitor dapagliflozin versus placebo in 17 160 patients with type 2 diabetes mellitus and either multiple risk factors for atherosclerotic cardiovascular disease (n=10 186) or known atherosclerotic cardiovascular disease (n=6974). We explored the effect of dapagliflozin on the first and total number of AF/AFL events in patients with (n=1116) and without prevalent AF/AFL using Cox and negative binomial models, respectively. AF/AFL events were identified by search of the safety database using MedDRA preferred terms (""atrial fibrillation,"" ""atrial flutter""). Results: Dapagliflozin reduced the risk of AF/AFL events by 19% (264 versus 325 events; 7.8 versus 9.6 events per 1000 patient-years; hazard ratio [HR], 0.81 [95% CI, 0.68-0.95]; P=0.009). The reduction in AF/AFL events was consistent regardless of presence or absence of a history of AF/AFL at baseline (previous AF/AFL: HR, 0.79 [95% CI, 0.58-1.09]; no AF/AFL: HR, 0.81 [95% CI, 0.67-0.98]; P for interaction 0.89). Similarly, presence of atherosclerotic cardiovascular disease (HR, 0.83 [95% CI, 0.66-1.04]) versus multiple risk factors (HR, 0.78 [95% CI, 0.62-0.99]; P for interaction 0.72) or a history of HF (HF: HR, 0.78 [95% CI, 0.55-1.11]; No HF: HR, 0.81 [95% CI, 0.68-0.97]; P for interaction 0.88) did not modify the reduction in AF/AFL events observed with dapagliflozin. Moreover, there was no effect modification by sex, history of ischemic stroke, glycated hemoglobin A(1c), body mass index, blood pressure, or estimated glomerular filtration rate (all P for interaction >0.20). Dapagliflozin also reduced the total number (first and recurrent) of AF/AFL events (337 versus 432; incidence rate ratio, 0.77 [95% CI, 0.64-0.92]; P=0.005). Conclusions: Dapagliflozin decreased the incidence of reported episodes of AF/AFL adverse events in high-risk patients with type 2 diabetes mellitus. This effect was consistent regardless of the patient's previous history of AF, atherosclerotic cardiovascular disease, or HF. Registration: URL: ; Unique identifier: NCT01730534.
  • article 9 Citação(ões) na Scopus
    Performance of acute coronary syndrome approaches in Brazil: a report from the BRACE (Brazilian Registry in Acute Coronary SyndromEs)
    (2020) FRANKEN, Marcelo; GIUGLIANO, Robert P.; GOODMAN, Shaun G.; BARACIOLI, Luciano Moreira; GODOY, Lucas Colombo; FURTADO, Remo H. M.; LIMA, Felipe Gallego; NICOLAU, Jose Carlos
    Aims Diagnostic and therapeutic tools have a significant impact on morbidity and mortality associated with acute coronary syndromes (ACS). Data about ACS performance measures are scarce in Brazil, and improving its collection is an objective of the Brazilian Registry in Acute Coronary syndromEs (BRACE). Methods and results The BRACE is a cross-sectional, observational epidemiological registry of ACS patients. Stratified 'cluster sampling' methodology was adopted to obtain a representative picture of ACS. A performance score (PS) varying from 0 to 100 was developed to compare studied parameters. Performance measures alone and the PS were compared between institutions, and the relationship between the PS and outcomes was evaluated. A total of 1150 patients, median age 63 years, 64% male, from 72 hospitals were included in the registry. The mean PS for the overall population was 65.9% +/- 20.1%. Teaching institutions had a significantly higher PS (71.4% +/- 16.9%) compared with non-teaching hospitals (63.4% +/- 21%; P <0.001). Overall in-hospital mortality was 5.2%, and the variables that correlated independently with in-hospital mortality included: PS perpoint increase (OR = 0.97, 95% CI 0.95-0.98, P < 0.001), age-per year (OR= 1.06, 95% CI 1.03-1.09, P < 0.001), chronic kidney disease (OR = 3.12, 95% CI 1.08-9.00, P = 0.036), and prior angioplasty (OR = 0.25, 95% CI 0.07-0.84, P = 0.025). Conclusions In BRACE, the adoption of evidence-based therapies for ACS, as measured by the performance score, was independently associated with lower in-hospital mortality. The use of diagnostic tools and therapeutic approaches for the management of ACS is less than ideal in Brazil, with high variability especially among different regions of the country.
  • article 42 Citação(ões) na Scopus
    Dapagliflozin and Cardiac, Kidney, and Limb Outcomes in Patients With and Without Peripheral Artery Disease in DECLARE-TIMI 58
    (2020) BONACA, Marc P.; WIVIOTT, Stephen D.; ZELNIKER, Thomas A.; MOSENZON, Ofri; BHATT, Deepak L.; LEITER, Lawrence A.; MCGUIRE, Darren K.; GOODRICH, Erica L.; FURTADO, Remo Holanda De Mendonca; WILDING, John P. H.; CAHN, Avivit; GAUSE-NILSSON, Ingrid A. M.; JOHANSON, Per; FREDRIKSSON, Martin; JOHANSSON, Peter A.; LANGKILDE, Anna Maria; RAZ, Itamar; SABATINE, Marc S.
    BACKGROUND: Patients with peripheral artery disease (PAD) are at heightened risk of cardiovascular complications. The sodium-glucose cotransporter 2 inhibitor dapagliflozin reduces the risk for hospitalization for heart failure (HHF) and kidney events in patients with type 2 diabetes mellitus. An increased risk of amputation has been observed with canagliflozin in 1 previous trial. We examined cardiovascular and kidney efficacy and the risk of limb-related events in patients with and without PAD in an exploratory analysis. METHODS: A total of 17 160 patients with type 2 diabetes mellitus, including 1025 (6%) with PAD, were randomized. Key efficacy outcomes were MACE (cardiovascular [CV] death, myocardial infarction, stroke), CV death/HHF, and progression of kidney disease. Amputations, peripheral revascularization, and limb ischemic adverse events were site-reported and categorized by a blinded reviewer. RESULTS: Patients in the placebo arm with PAD versus those without tended to have higher adjusted risk of CV death, myocardial infarction, or stroke (adjusted hazard ratio [HR], 1.23 [95% CI, 0.97-1.56],P=0.094) and significantly higher adjusted risk of CV death/HHF (adjusted HR, 1.60 [95% CI, 1.21-2.12],P=0.0010) and progression of kidney disease (adjusted HR, 1.51 [95% CI, 1.13 - 2.03],P=0.0058), and limb adverse events (adjusted HR, 8.37,P<0.001). The relative risk reductions with dapagliflozin for CV death/HHF (HR, 0.86, PAD; HR, 0.82, no-PAD;P-interaction=0.79) and progression of kidney disease (HR, 0.78, PAD; HR, 0.76, no-PAD;P-interaction=0.84) were consistent regardless of PAD. There were 560 patients who had at least 1 limb ischemic event, 454 patients with at least 1 peripheral revascularization, and 236 patients with at least 1 amputation, with a total of 407 amputations reported. Overall, there were no significant differences in any limb outcome with dapagliflozin versus placebo including limb ischemic adverse events (HR, 1.07 [95% CI, 0.90-1.26]) and amputation (HR, 1.09 [95% CI, 0.84-1.40]), with no significant interactions by a history of PAD versus not (P-interactions=0.30 and 0.093, respectively). CONCLUSIONS: Patients with versus without PAD are at a higher risk of CV death of CV death, HHF, and kidney outcomes, and have a consistent benefits for CV death/HHF and progression of kidney disease with dapagliflozin. Patients with PAD had a higher risk of limb events, with no consistent pattern of incremental risk observed with dapagliflozin.
  • article 149 Citação(ões) na Scopus
    Dapagliflozin in patients with cardiometabolic risk factors hospitalised with COVID-19 (DARE-19): a randomised, double-blind, placebo-controlled, phase 3 trial
    (2021) KOSIBOROD, Mikhail N.; ESTERLINE, Russell; FURTADO, Remo H. M.; OSCARSSON, Jan; GASPARYAN, Samvel B.; KOCH, Gary G.; MARTINEZ, Felipe; MUKHTAR, Omar; VERMA, Subodh; CHOPRA, Vijay; BUENCONSEJO, Joan; LANGKILDE, Anna Maria; AMBERY, Philip; TANG, Fengming; GOSCH, Kensey; WINDSOR, Sheryl L.; AKIN, Emily E.; SOARES, Ronaldo V. P.; MOIA, Diogo D. F.; ABOUDARA, Matthew; HOFFMANN FILHO, Conrado Roberto; FEITOSA, Audes D. M.; FONSECA, Alberto; GARLA, Vishnu; GORDON, Robert A.; JAVAHERI, Ali; JAEGER, Cristiano P.; LEAES, Paulo E.; NASSIF, Michael; PURSLEY, Michael; SILVEIRA, Fabio Serra; BARROSO, Weimar Kunz Sebba; SOTO, Jose Roberto Lazcano; MAIA, Lilia Nigro; BERWANGER, Otavio
    Background COVID-19 can lead to multiorgan failure. Dapagliflozin, a SGLT2 inhibitor, has significant protective benefits for the heart and kidney. We aimed to see whether this agent might provide organ protection in patients with COVID-19 by affecting processes dysregulated during acute illness. Methods DARE-19 was a randomised, double-blind, placebo-controlled trial of patients hospitalised with COVID-19 and with at least one cardiometabolic risk factor (ie, hypertension, type 2 diabetes, atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease). Patients critically ill at screening were excluded. Patients were randomly assigned 1:1 to dapagliflozin (10 mg daily orally) or matched placebo for 30 days. Dual primary outcomes were assessed in the intention-to-treat population: the outcome of prevention (time to new or worsened organ dysfunction or death), and the hierarchial composite outcome of recovery (change in clinical status by day 30). Safety outcomes, in patients who received at least one study medication dose, included serious adverse events, adverse events leading to discontinuation, and adverse events of interest. This study is registered with ClinicalTrials.gov, NCT04350593. Findings Between April 22, 2020 and Jan 1, 2021, 1250 patients were randomly assigned with 625 in each group. The primary composite outcome of prevention showed organ dysfunction or death occurred in 70 patients (11middot2%) in the dapagliflozin group, and 86 (13middot8%) in the placebo group (hazard ratio [HR] 0middot80, 95% CI 0middot58-1middot10; p=0middot17). For the primary outcome of recovery, 547 patients (87middot5%) in the dapagliflozin group and 532 (85middot1%) in the placebo group showed clinical status improvement, although this was not statistically significant (win ratio 1middot09, 95% CI 0middot97-1middot22; p=0middot14). There were 41 deaths (6middot6%) in the dapagliflozin group, and 54 (8middot6%) in the placebo group (HR 0middot77, 95% CI 0middot52-1middot16). Serious adverse events were reported in 65 (10middot6%) of 613 patients treated with dapagliflozin and in 82 (13middot3%) of 616 patients given the placebo. Interpretation In patients with cardiometabolic risk factors who were hospitalised with COVID-19, treatment with dapagliflozin did not result in a statistically significant risk reduction in organ dysfunction or death, or improvement in clinical recovery, but was well tolerated. Funding AstraZeneca.
  • article 0 Citação(ões) na Scopus
    Dapagliflozin in patients with COVID-19: mind the kidneys reply
    (2022) KOSIBOROD, Mikhail N.; ESTERLINE, Russell; OSCARSSON, Jan; GASPARYAN, Samvel B.; FURTADO, Remo H. M.; VERMA, Subodh; BERWANGER, Otavio
  • article 10 Citação(ões) na Scopus
    Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization
    (2021) NAKASHIMA, Carlos A. K.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; JATENE, Fabio B.; HAJJAR, Ludhmila A.; SOEIRO, Alexandre M.; FURTADO, Remo H. M.; DALCOQUIO, Talia F.; BARACIOLI, Luciano M.; LIMA, Felipe G.; V, Roberto R. C. Giraldez; SILVA, Bianca A.; COSTA, Mateus S. S.; STRUNZ, Celia M. C.; DALLAN, Luis R. P.; BARBOSA, Carlos J. D. G.; BRITTO, Flavia A. B.; FARKOUH, Michael E.; GURBEL, Paul A.; NICOLAU, Jose C.
    BACKGROUND Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications. OBJECTIVES This study aimed to evaluate if a platelet reactivity-based strategy is noninferior to standard of care for 24-h post-CABG bleeding. METHODS In this randomized, open label noninferiority trial, 190 patients admitted with ACS with indications for CABG and on aspirin and P2Y(12) receptor inhibitors, were assigned to either control group, P2Y(12) receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day after platelet reactivity normalization (predefined as >= 46 aggregation units). RESULTS Within the first 24 h of CABG, the median chest tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and 350 ml (IQR: 255 to 500 ml) in the intervention and control groups, respectively (p for noninferiority <0.001). The median waiting period between the decision to undergo CABG and the procedure was 112 h (IQR: 66 to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the intention-to-treat analysis, a 6.4% decrease in the median in-hospital expenses was observed in the intervention group (p = 0.014), with 11.2% decrease in the analysis per protocol (p = 0.003). CONCLUSIONS A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with ACS awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses. (C) 2021 by the American College of Cardiology Foundation.
  • article 2 Citação(ões) na Scopus
    Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction
    (2020) NICOLAU, Jose C.; BRIEGER, David; OWEN, Ruth; FURTADO, Remo H. M.; GOODMAN, Shaun G.; COHEN, Mauricio G.; SIMON, Tabassome; WESTERMANN, Dirk; GRANGER, Christopher B.; GRIEVE, Richard; YASUDA, Satoshi; CHEN, Jiyan; HEDMAN, Katarina; MELLSTROM, Carl; BRANDRUP-WOGNSEN, Gunnar; POCOCK, Stuart J.
    Background Diabetes mellitus (DM) is associated with increased cardiovascular (CV) risk. We compared health-related quality of life (HRQoL), healthcare resource utilization (HRU), and clinical outcomes of stable post-myocardial infarction (MI) patients with and without DM. Hypothesis In post-MI patients, DM is associated with worse HRQoL, increased HRU, and worse clinical outcomes. Methods The prospective, observational long-term risk, clinical management, and healthcare Resource utilization of stable coronary artery disease study obtained data from 8968 patients aged >= 50 years 1 to 3 years post-MI (369 centers; 25 countries). Patients with >= 1 of the following risk factors were included: age >= 65 years, history of a second MI >1 year before enrollment, multivessel coronary artery disease, creatinine clearance >= 15 and <60 mL/min, and DM treated with medication. Self-reported health status was assessed at baseline, 1 and 2 years and converted to EQ-5D scores. The main outcome measures were baseline HRQoL and HRU during follow-up. Results DM at enrollment was 33% (2959 patients, 869 insulin treated). Mean baseline EQ-5D score (0.86 vs 0.82; P < .0001) was higher; mean number of hospitalizations (0.38 vs 0.50, P < .0001) and mean length of stay (LoS; 9.3 vs 11.5; P = .001) were lower in patients without vs with DM. All-cause death and the composite of CV death, MI, and stroke were significantly higher in DM patients, with adjusted 2-year rate ratios of 1.43 (P < .01) and 1.55 (P < .001), respectively. Conclusions Stable post-MI patients with DM (especially insulin treated) had poorer EQ-5D scores, higher hospitalization rates and LoS, and worse clinical outcomes vs those without DM. Strategies focusing specifically on this high-risk population should be developed to improve outcomes. Trial registration : NCT01866904 ().
  • article 1 Citação(ões) na Scopus
    Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry
    (2023) NICOLAU, Jose Carlos; OWEN, Ruth; FURTADO, Remo H. M.; GOODMAN, Shaun G.; GRANGER, Christopher B.; COHEN, Mauricio G.; WESTERMANN, Dirk; YASUDA, Satoshi; SIMON, Tabassome; HEDMAN, Katarina; HUNT, Phillip R.; BRIEGER, David B.; POCOCK, Stuart J.
    Background Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post- acute myocardial infarction (AMI) populations in rural and urban settings are limited.Methods The long- Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged =50 years 1-3 years post -AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all- cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months.Results There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all- cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke.Conclusions Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed.