Key result
In patients referred for coronary angiography not on oral anticoagulants, a 1-SD increase in INR was associated with a higher risk of all-cause mortality (HR 1.14), though this association was rendered insignificant after adjusting for NT-proBNP.
Why the study?
The INR is typically used to monitor oral anticoagulant therapy, but its association with mortality in CAD patients not receiving oral anticoagulants was unknown.
Is high-normal INR associated with increased mortality in patients referred for coronary angiography who are not on oral anticoagulant therapy?
Cohort (n=3,064)
No
Is high-normal INR associated with increased mortality in patients referred for coronary angiography who are not on oral anticoagulant therapy?
Hazard Ratio: 1.14 (95% CI 1.07–1.21)
High-normal INR is associated with increased mortality in patients with or without CAD not on anticoagulants, but this association is likely driven by underlying heart failure as indicated by NT-proBNP levels.
High-normal INR was associated with mortality in CAD patients off anticoagulation; leaves open whether it is a useful marker beyond NT-proBNP.
AIMS: The international-normalized-ratio (INR) is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The aim of our study was to investigate the association of the INR with mortality in coronary artery disease (CAD) patients not on oral anticoagulant therapy. METHODS AND RESULTS: Between 1997 to 2000 the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study enrolled 3316 patients of German ancestry that had been referred for coronary angiography. We excluded patients on coumarin therapy (n = 222) and patients with an INR more than 5 standard deviations (SD) away from the mean (n = 30). During a median follow-up of 9.9 years, 884 patients died, 547 patients from cardiovascular causes. After adjustment for cardiovascular risk factors the INR was associated with all-cause mortality in all patients and the CAD positive group with HRs (95% CI) of 1.14(1.07-1.21) and 1.16(1.09-1.23) per 1-SD increase, respectively. Adjustment for NT-proBNP rendered the association insignificant. CONCLUSION: In LURIC, the INR was positively associated with mortality in patients with prevalent CAD not on oral anticoagulant therapy as well as in patients without CAD. Adjustment for NT-proBNP abolished the association suggesting clinical or subclinical heart failure strongly contributing to increased INR and higher mortality.
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Delgado et al. (2019) conducted a cohort in Coronary artery disease (referred for coronary angiography) (n=3,064). High-normal international-normalized-ratio (INR) vs. Lower INR was evaluated on All-cause mortality (HR 1.14, 95% CI 1.07-1.21). In patients referred for coronary angiography not on oral anticoagulants, a 1-SD increase in INR was associated with a higher risk of all-cause mortality (HR 1.14), though this association was rendered insignificant after adjusting for NT-proBNP.
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