Fabrizio D'Ascenzo1, Andrea Saglietto1, Harish Ramakrishna2, Alessandro Andreis1, Jesús M Jiménez-Mazuecos3, Luis Nombela-Franco4, Enrico Cerrato5, Christoph Liebetrau6,7, Emilio Alfonso-Rodríguez8, Rodrigo Bagur9, Mohamad Alkhouli10, Gaetano M De Ferrari1, Iván J Núñez-Gil4,11. 1. Cardiology, Città della Salute e della Scienza, Molinette Hospital, Torino, Italy. 2. Division of Cardiovascular Anesthesiology, Mayo Clinic Rochester, Arizona. 3. Interventional Cardiology, H General Universitario de Albacete, Albacete, Spain. 4. Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain. 5. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (Turin), Italy. 6. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 7. Partner Site Rhein-Main, DZHK (German Centre for Cardiovascular Research), Frankfurt am Main, Germany. 8. Cardiology Division, Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba. 9. Interventional Cardiology, University Hospital, London Health Sciences Centre, London, Ontario, Canada. 10. Cardiovascular Division, Mayo Clinic Rochester, MN. 11. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Abstract
OBJECTIVES: To assess the Usefulness of oral anticoagulation therapy (OAT) in patients with coronary artery aneurysm (CAA). BACKGROUND: Data on the most adequate antithrombotic CAA management is lacking. METHODS: Patients included in CAAR (Coronary Artery Aneurysm Registry, Clinical Trials.gov: NCT02563626) were selected. Patients were divided in OAT and non-OAT groups, according to anticoagulation status at discharge and 2:1 propensity score matching with replacement was performed. The primary endpoint of the analysis was a composite and mutual exclusive endpoint of myocardial infarction, unstable angina (UA), and aneurysm thrombosis (coronary ischemic endpoint). Net adverse clinical events, major adverse cardiovascular events, their single components, cardiovascular death, re-hospitalizations for heart failure, stroke, aneurysm thrombosis, and bleeding were the secondary ones. RESULTS: One thousand three hundred thirty-one patients were discharged without OAT and 211 with OAT. In the propensity-matched sample (390 patients in the non-OAT group, 195 patients in the OAT group), after 3 years of median follow-up (interquartile range 1-6 years), the rate of the primary endpoint (coronary ischemic endpoint) was significantly less in the OAT group as compared to non-OAT group (8.7 vs. 17.2%, respectively; p = .01), driven by a significant reduction in UA (4.6 vs. 10%, p < .01) and aneurysm thrombosis (0 vs. 3.1%, p = .03), along with a non-significant reduction in MI (4.1 vs. 7.7%, p = .13). A non-significant increase in bleedings, mainly BARC type 1 (55%), was found in the OAT-group (10.3% in the non-OAT vs. 6.2% in the OAT group, p = .08). CONCLUSION: OAT decreases the composite endpoint of UA, myocardial infarction, and aneurysm thrombosis in patients with CAA, despite a non-significant higher risk of bleeding.
OBJECTIVES: To assess the Usefulness of oral anticoagulation therapy (OAT) in patients with coronary artery aneurysm (CAA). BACKGROUND: Data on the most adequate antithrombotic CAA management is lacking. METHODS: Patients included in CAAR (Coronary Artery Aneurysm Registry, Clinical Trials.gov: NCT02563626) were selected. Patients were divided in OAT and non-OAT groups, according to anticoagulation status at discharge and 2:1 propensity score matching with replacement was performed. The primary endpoint of the analysis was a composite and mutual exclusive endpoint of myocardial infarction, unstable angina (UA), and aneurysm thrombosis (coronary ischemic endpoint). Net adverse clinical events, major adverse cardiovascular events, their single components, cardiovascular death, re-hospitalizations for heart failure, stroke, aneurysm thrombosis, and bleeding were the secondary ones. RESULTS: One thousand three hundred thirty-one patients were discharged without OAT and 211 with OAT. In the propensity-matched sample (390 patients in the non-OAT group, 195 patients in the OAT group), after 3 years of median follow-up (interquartile range 1-6 years), the rate of the primary endpoint (coronary ischemic endpoint) was significantly less in the OAT group as compared to non-OAT group (8.7 vs. 17.2%, respectively; p = .01), driven by a significant reduction in UA (4.6 vs. 10%, p < .01) and aneurysm thrombosis (0 vs. 3.1%, p = .03), along with a non-significant reduction in MI (4.1 vs. 7.7%, p = .13). A non-significant increase in bleedings, mainly BARC type 1 (55%), was found in the OAT-group (10.3% in the non-OAT vs. 6.2% in the OAT group, p = .08). CONCLUSION: OAT decreases the composite endpoint of UA, myocardial infarction, and aneurysm thrombosis in patients with CAA, despite a non-significant higher risk of bleeding.
Authors: Luca Esposito; Marco Di Maio; Angelo Silverio; Francesco Paolo Cancro; Michele Bellino; Tiziana Attisano; Fabio Felice Tarantino; Giovanni Esposito; Carmine Vecchione; Gennaro Galasso; Cesare Baldi Journal: Front Cardiovasc Med Date: 2022-02-04