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Published on: January 21, 2018
Myocardial Infarction, Stroke, and Death after Intravitreal Injection of Anti-VEGF in a Nationwide Study
Caroline Conese1, Eric Benzenine2, Anne-Sophie Mariet2,3,4
1Département d'ophtalmologie, Université Bourgogne Europe, CHU Dijon Bourgogne, Dijon, France.
Objective:
To assess the risk of myocardial infarction, stroke, and death after intravitreal injection (IVT) of anti-vascular endothelial growth factor (VEGF) on a national scale.
Design:
A controlled cohort study from 2010 to 2016 in France.
Subjects Participants And Controls:
Patients receiving an anti-VEGF IVT or undergoing cataract surgery.
Main Outcome Measures:
Occurrence of myocardial infarction, stroke, or death.
Results:
We compared 334 663 patients starting treatment with anti-VEGF IVT with 981 172 matched control patients undergoing cataract surgery. The occurrence of the main outcome, i.e., myocardial infarction, stroke, or death, was low at 28 days: 0.2% in both groups (n = 670 in the IVT group and n = 1988 in the control group). In multivariable analysis, there was no increase in myocardial infarction, stroke, or death in the IVT group at 28 days (adjusted risk ratio [RR] 0.96; 95% confidence interval [CI] 0.88-1.05; P = 0.42). Moreover, no additional risk was observed in patients with diabetes or a history of stroke or myocardial infarction. In the subgroup analysis, results were similar for the main outcome whatever the agent used for the first anti-VEGF IVT (ranibizumab: adjusted RR 0.97; 95% CI 0.89-1.07; P = 0.59; and aflibercept: adjusted RR 0.82; 95% CI 0.65-1.04; P = 0.10).
Conclusions:
The overall risk of the main outcome was low after 1 IVT. In the stratified analysis of aflibercept and ranibizumab IVT, no difference was found in the risk for the main outcome between the 2 agents.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
