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Impact of chronic oral anticoagulation on management and outcomes of patients with acute myocardial infarction: data from the RICO survey
  1. A Oudot1,
  2. P G Steg2,
  3. N Danchin3,
  4. G Dentan4,
  5. M Zeller1,
  6. P Sicard1,
  7. P Buffet1,
  8. Y Laurent5,
  9. L Janin-Manificat6,
  10. I L’Huillier1,
  11. J C Beer1,
  12. H Makki7,
  13. P Morel8,
  14. Y Cottin1
  1. 1Service de Cardiologie, CHU Bocage, Dijon, France
  2. 2Service de Cardiologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
  3. 3Service de Cardiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
  4. 4Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France
  5. 5Service de Cardiologie, Centre Hospitalier, Semur en Auxois, France
  6. 6Service de Cardiologie, Centre Hospitalier, Beaune, France
  7. 7Service de Cardiologie, Centre Hospitalier, Châtillon sur Seine, France
  8. 8Etablissement Français du Sang Bourgogne/Franche-Comté, CHU Bocage, Dijon, France
  1. Correspondence to:
    Dr Yves Cottin
    Service de Cardiologie, CHU Dijon, Bd de Lattre de Tassigny, 21034 Dijon Cedex, France; yves.cottin{at}chu-dijon.fr

Abstract

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.

  • AMI, acute myocardial infarction
  • COA, chronic oral anticoagulant drug treatment
  • INR, international normalised ratio
  • PCI, percutaneous coronary intervention
  • STEMI, ST elevation myocardial infarction
  • TIMI, thrombolysis in myocardial infarction
  • acute myocardial infarction
  • chronic oral anticoagulation
  • management
  • outcome

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Footnotes

  • Published Online First 30 December 2005

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