Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/11283
Title
Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study.
Author(s)
Date issued
2020-01
Citation
Curr Vasc Pharmacol. 2020; 18(1):92-99
Language
Inglés
Document type
journal article
Abstract
To analyze characteristics, management and outcomes of patients with acute coronary syndromes (ACS) receiving chronic oral anticoagulant (OAC) therapy enrolled in the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients) prospective, international, observational study of antithrombotic management patterns in ACS survivors (NCT01171404).
This post-hoc analysis evaluated the association between OAC use at baseline (OACb) and time from hospital admission to percutaneous coronary intervention (PCI) (tHA-PCI), pre-PCI thrombolysis in myocardial infarction (TIMI) 3 flow, stent type, length of hospitalization, and clinical endpoints; death, non-fatal MI, and non-fatal stroke, a composite of these ± bleeding, over 2 years' followup.
Of 10,568 ACS patients, 345 (3.3%) were on OACb (non-ST-segment elevation ACS [NSTEACS], n=268; ST-segment elevation MI [STEMI], n=77). OACb patients were older with more comorbidities. In NSTE-ACS OACb patients, tHA-PCI was longer (median 57.4 vs. 27.8 h; p=.008), and TIMI 3 flow rarer (26.0 vs. 33.5%; p=0.035). OACb patients had longer mean hospital stay (NSTEACS: 8.9 vs. 7.6 days; p<0.001; STEMI: 9.5 vs. 7.8 days; p=0.015), and higher rates of the composite endpoint (NSTE-ACS: 16.8 vs. 8.8%; p<0.0001; STEMI: 23.4 vs. 5.9%; p<0.0001). Bleeding events were more common with OACb (NSTE-ACS: 6.0 vs. 3.3%; p=0.01; STEMI: 6.5 vs. 2.8%; p=0.04).
At 2-years, OACb use was associated with an increased risk of cardiovascular and bleeding events in STEMI and NSTE-ACS. NSTE-ACS patients on OACb experienced prolonged time to intervention, lower rates of TIMI 3 flow and longer hospitalization.
MESH
Percutaneous Coronary Intervention | Acute Coronary Syndrome | Administration, Oral | Aged | Aged, 80 and over | Anticoagulants | Comorbidity | Drug Administration Schedule | Drug Utilization | Dual Anti-Platelet Therapy | Europe | Female | Fibrinolytic Agents | Hemorrhage | Humans | Latin America | Male | Middle Aged | Non-ST Elevated Myocardial Infarction | Platelet Aggregation Inhibitors | Practice Patterns, Physicians' | Prospective Studies | Risk Assessment | Risk Factors | ST Elevation Myocardial Infarction | Time Factors | Treatment Outcome
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