Impact of chronic oral anticoagulation on management and outcomes of patients with acute myocardial infarction: data from the RICO survey
| Autor: | Jean-Claude Beer, Yves Cottin, Luc Janin-Manificat, Marianne Zeller, Isabelle L’Huillier, Philippe Gabriel Steg, Pierre Sicard, Yves Laurent, Alexandra Oudot, Nicolas Danchin, Pascal Morel, Gilles Dentan, Hamid Makki, Philippe Buffet |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty Vitamin K Heart disease Myocardial Ischemia Myocardial Infarction Administration Oral Myocardial Reperfusion Cardiovascular Medicine Reperfusion therapy Fibrinolytic Agents Recurrence Risk Factors Internal medicine medicine Prevalence Humans Thrombolytic Therapy Drug Interactions cardiovascular diseases Myocardial infarction Adverse effect Aged Aspirin business.industry Contraindications Anticoagulants Odds ratio Middle Aged medicine.disease Prognosis Antifibrinolytic Agents Surgery Editorial Multivariate Analysis Platelet aggregation inhibitor Female France Cardiology and Cardiovascular Medicine business Fibrinolytic agent Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Heart (British Cardiac Society). 92(8) |
| ISSN: | 1468-201X |
| Popis: | Objective: To determine the prevalence of chronic oral anticoagulant drug treatment (COA) among patients with acute myocardial infarction (AMI) and its impact on management and outcome. Methods: All patients with ST segment elevation AMI on the RICO (a French regional survey for AMI) database were included in this analysis. COA was defined as continuous use ⩾ 48 hours before AMI. Results: Among the 2112 patients with ST elevation myocardial infarction (STEMI), 93 (4%) patients were receiving COA. These patients were older and more likely to have a history of hypertension, diabetes and prior myocardial infarction than patients without COA. In addition, fewer patients who received COA underwent reperfusion therapy or received an antiplatelet agent (aspirin/thienopyridines). Moreover, patients receiving COA experienced a higher incidence of in-hospital major adverse events (death, recurrent myocardial infarction or major bleeding, p = 0.005). Multivariate analysis showed that only ejection fraction, current smoking and multiple vessel disease, but not COA, were independent predictive factors for major adverse events. In contrast, COA was an independent predictive factor for heart failure when adjusted for age, diabetes, creatinine clearance, reperfusion, heparin and glycoprotein IIb/IIIa inhibitors (odds ratio 2.06, CI 95% 1.23 to 3.43, p = 0.005). Conclusion: In this population based registry, patients with STEMI with prior use of COA constituted a fairly large group (4%) with an overall higher baseline risk profile than that of patients without COA. Fewer in the COA group received reperfusion therapy or aggressive antithrombotic treatment and they experienced more adverse in-hospital outcomes. Thus, further studies are warranted to develop specific management strategies for this high risk group. |
| Databáze: | OpenAIRE |
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