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A Journal on Heart and Vascular Diseases

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2011 October;59(5):499-506


language: English

Coronary stenting for ST-elevation myocardial infarction vs. other indications in patients on oral anticoagulation: any difference in in-hospital management and outcome?

Vecchio S. 1, Zanolla L. 2, Valencia J. 3, Colletta M. 4, Capecchi A. 5, Franco N. 6, Piovaccari G. 6, Margheri M. 1, Di Pasquale G. 4, Rubboli A. 4

1 Division of Cardiology and Interventional Center, Santa Maria delle Croci Hospital, Ravenna, Italy 2 Division of Cardiology, Università degli Studi, Verona, Italy 3 Cardiac Catheterization Laboratory, Hospital General Universitario, Alicante, Spain 4 Division of Cardiology and Cardiac Catheterization Laboratory,, Ospedale Maggiore, Bologna, Italy 5 Division of Cardiology, Ospedale Civile, Bentivoglio, Italy 6 Division of Cardiology, Ospedale degli Infermi, Rimini, Italy


AIM: The aim of this paper was to compare the in-hospital management and outcome of patients on oral anticoagulation (OAC) undergoing coronary artery stenting (PCI-S) for ST-elevation myocardial infarction (STEMI) vs. other indications.
METHODS:One hundred and sixteen patients on OAC at the time of PCI-S who were prospectively enrolled in a multi-center, observational registry, were evaluated. Patients were segregated according to whether PCI-S was performed for STEMI (group 1) or other indications, such as non ST-elevation acute coronary syndromes, stable angina, silent ischemia, etc. (group 2), and the pharmacological and procedural management, as well as the in-hospital outcome, were compared.
RESULTS: No significant differences were observed in vascular access site, sheath size and type of stent implanted, nor was significantly different the use of glycoprotein IIb/IIIa inhibitors, and the use and dose of intravenous unfractionated heparin. Although not statistically different, the in-hospital occurrence of death (3.7% vs. 1.1%; OR 3.3; 95% confidence intervals [CI] 0.2-56.0), stent thrombosis (3.7% vs. 1.1%; OR 3.3; 95% CI 0.2-56.0) and major bleeding (7.4% vs. 2.2%; OR 3.4; 95% CI 0.4-25.9) was consistently about 3-fold higher in group 1.
CONCLUSION: The in-hospital pharmacological and procedural management of OAC patients undergoing PCI-S for STEMI vs. other indications appears not different. Although not significantly different however, the in-hospital occurrence of major bleeding, as well as of death and stent thrombosis, appears substantially higher in patients treated for STEMI, warranting therefore further larger, prospective studies.

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