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Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study.
Curr Vasc Pharmacol. 2020; 18(1):92-99.CV

Abstract

OBJECTIVE

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).

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Authors+Show Affiliations

Department of Intensive Cardiac Therapy, Institute of Cardiology, Warsaw, Poland.Department of Intensive Cardiac Therapy, Institute of Cardiology, Warsaw, Poland.Department of Public Health, I-CHER Interuniversity Centre for Health Economics Research, UGent and VUB, Ghent, Belgium.Department of Cardiology Hopital Europeen Georges Pompidou, Université Paris Descartes, Paris, France.Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain.Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

30588886

Citation

Stepinska, Janina, et al. "Long-Term Outcome of Acute Coronary Syndromes in Patients On Chronic Oral Anticoagulants: Data From the EPICOR Study." Current Vascular Pharmacology, vol. 18, no. 1, 2020, pp. 92-99.
Stepinska J, Wojtkowska I, Annemans L, et al. Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study. Curr Vasc Pharmacol. 2020;18(1):92-99.
Stepinska, J., Wojtkowska, I., Annemans, L., Danchin, N., Pocock, S. J., de Werf, F. V., Medina, J., & Bueno, H. (2020). Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study. Current Vascular Pharmacology, 18(1), 92-99. https://doi.org/10.2174/1570161117666181227122355
Stepinska J, et al. Long-Term Outcome of Acute Coronary Syndromes in Patients On Chronic Oral Anticoagulants: Data From the EPICOR Study. Curr Vasc Pharmacol. 2020;18(1):92-99. PubMed PMID: 30588886.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study. AU - Stepinska,Janina, AU - Wojtkowska,Izabela, AU - Annemans,Lieven, AU - Danchin,Nicolas, AU - Pocock,Stuart J, AU - de Werf,Frans Van, AU - Medina,Jesús, AU - Bueno,Hector, PY - 2018/10/08/received PY - 2018/12/22/revised PY - 2018/12/22/accepted PY - 2018/12/28/pubmed PY - 2020/9/29/medline PY - 2018/12/28/entrez KW - Acute coronary syndrome KW - DAPT KW - EPICOR KW - OAC KW - PCI KW - oral anticoagulant. SP - 92 EP - 99 JF - Current vascular pharmacology JO - Curr Vasc Pharmacol VL - 18 IS - 1 N2 - OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSION: 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. SN - 1875-6212 UR - https://www.unboundmedicine.com/medline/citation/30588886/Long_Term_Outcome_of_Acute_Coronary_Syndromes_in_Patients_on_Chronic_Oral_Anticoagulants:_Data_from_the_EPICOR_Study_ L2 - http://www.eurekaselect.com/168610/article DB - PRIME DP - Unbound Medicine ER -