Outcomes among patients with non-ST-elevation myocardial infarction on chronic anticoagulation: Insights from the National Inpatient Sample

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-08-27 DOI:10.1002/ccd.31198

Ahmed M. Younes MD, Ahmed Hashem MBChB, Ahmed Maraey MD, Mahmoud Khalil MD, Ahmed Elzanaty MD, MPH, Islam Y. Elgendy MD, FACC, FAHA, FSCAI, FSVM

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引用次数: 0

Abstract

Background

Chronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non-ST-elevation myocardial infarction (NSTEMI).

Aims

To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation.

Methods

Using the National Inpatient Sample (NIS) years 2016–2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD-10) appropriate codes. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient-level and hospital-level factors.

Results

Among 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in-hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65−0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88−1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03−1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76−0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41−0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: −0.8 days, 95% CI: −0.86 to −0.75, p < 0.001) and (aMD: $−19,340, 95% CI: −20,692 to −17,988, p < 0.001).

Conclusions

Among patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in-hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.

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长期抗凝的非 ST 段抬高型心肌梗死患者的预后：来自全国住院病人抽样调查的启示。

背景：长期使用全身抗凝治疗各种血栓栓塞性疾病十分普遍。目的：评估长期服用抗凝药的 NSTEMI 患者的院内预后：利用2016-2020年全国住院患者样本（NIS），使用相应的国际疾病分类第10版（ICD-10）代码确定NSTEMI患者和长期抗凝患者。主要结果是全因院内死亡率，次要结果包括大出血、缺血性脑血管意外（CVA）、早期经皮冠状动脉介入治疗（PCI）（即入院 24 小时内）、住院期间冠状动脉旁路移植术（CABG）、住院时间（LOS）和总费用。在对患者层面和医院层面的因素进行调整后，进行了多变量逻辑或线性回归分析：在 2,251,914 名 NSTEMI 成年患者中，有 190,540 人（8.5%）长期服用抗凝药。慢性抗凝与较低的院内死亡率相关（调整后的几率比 [aOR]：0.69，95% 置信区间：0.69）：0.69，95% 置信区间 [CI]：0.65-0.73, p 结论：在入院的 NSTEMI 患者中，长期服用抗凝药物与较低的院内死亡率、住院时间和总费用相关，但大出血的发生率没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.