December 27, 2018Current Vascular PharmacologyOpen Access

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

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Why the study?

The characteristics, management, and long-term outcomes of ACS patients receiving chronic oral anticoagulant therapy were analyzed from a prospective registry.

Does chronic oral anticoagulant therapy at baseline affect clinical outcomes and management timelines in patients presenting with acute coronary syndromes?

Structured PICO

Does chronic oral anticoagulant therapy at baseline affect clinical outcomes and management timelines in patients presenting with acute coronary syndromes?

Population

10,568 patients with acute coronary syndromes (ACS) (NSTEACS and STEMI) enrolled in the EPICOR prospective, international, observational study.

Intervention

Chronic oral anticoagulant (OAC) therapy at baseline

Comparator

No chronic oral anticoagulant therapy at baseline

Outcome

Composite of death, non-fatal MI, and non-fatal stroke ± bleeding over 2 years' follow-upcomposite

Patients presenting with ACS while on chronic oral anticoagulation represent a high-risk population that experiences delayed invasive management, longer hospitalizations, and worse long-term ischemic and bleeding outcomes.

Limitations

Post-hoc analysis

Implication

Baseline OAC in ACS linked to higher CV/bleeding events; leaves open optimal regimens in this population.

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.