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In‐hospital outcomes of STEMI patients on warfarin undergoing primary PCI
Author(s) -
Marbach Jeffrey A.,
Almufleh Aws,
Bernick Jordan,
Blondeau Melissa,
Osborne Christina,
Russo Juan,
Hibbert Benjamin,
Froeschl Michael,
Labinaz Marino,
Glover Christopher,
Dick Alexander,
So Derek,
Chong AunYeong,
Le May Michel
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27720
Subject(s) - medicine , mace , warfarin , timi , myocardial infarction , percutaneous coronary intervention , conventional pci , cardiology , clinical endpoint , ticagrelor , killip class , atrial fibrillation , randomized controlled trial
Objectives We sought to describe the safety and efficacy outcomes of patients on warfarin presenting with ST‐elevation myocardial infarction (STEMI). Background Limited data exist on the outcomes and optimal management of STEMI patients on warfarin undergoing primary percutaneous coronary intervention (PCI). Methods Baseline characteristics and outcomes were prospectively collected for 2,390 consecutive STEMI patients referred for primary PCI. Patients were stratified based on warfarin use at baseline. The primary safety endpoint was the rate of in‐hospital bleeding (a composite of major bleeding or minor bleeding) according to the thrombolysis in myocardial infarction (TIMI) classification. Efficacy endpoints included major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, as well as intracranial bleeding, cardiogenic shock, and length of stay. Multiple logistic regression was used to determine if warfarin was independently associated with bleeding and MACE. Results Warfarin patients ( n = 59 vs. n = 2,331) were significantly older (73.2 years vs. 61.7 years; P < 0.01), and more likely to present as Killip Class IV (13.6% vs. 2.7%; P < 0.01). TIMI major/minor bleeding occurred in 30.4% of the warfarin patients and 14.2% of the control patients ( P < 0.01). After adjustment warfarin was independently associated with an increased risk of bleeding (OR 2.08; P = 0.04). Warfarin patients also had an increased frequency of MACE (20.3% vs. 5.9%; P < 0.01), though this was not significant after adjustment (OR 2.00; P = 0.10). Conclusions STEMI patients on warfarin referred for primary PCI are more likely to experience bleeding. New strategies are needed to optimize the management and minimize bleeding in this high‐risk population.