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Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study

[ Vol. 18 , Issue. 1 ]

Author(s):

Janina Stepinska*, Izabela Wojtkowska, Lieven Annemans, Nicolas Danchin, Stuart J Pocock, Frans Van de Werf, Jesús Medina and Hector Bueno   Pages 92 - 99 ( 8 )

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.

Keywords:

Acute coronary syndrome, oral anticoagulant, EPICOR, PCI, OAC, DAPT.

Affiliation:

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



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