Affiliation:
1. Department of Internal Medicine Riverside Shore Memorial Hospital Onancock Virginia USA
2. Department of Cardiology Ain Shams University Cairo Egypt
3. Department of Cardiology University of Toledo Medical Center Toledo Ohio USA
4. Department of Cardiology University of Connecticut Medical Center Farmington Connecticut USA
5. Division of Cardiovascular Medicine Gill Heart Institute, University of Kentucky Lexington Kentucky USA
Abstract
AbstractBackgroundChronic 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).AimsTo evaluate the in‐hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation.MethodsUsing 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.ResultsAmong 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).ConclusionsAmong 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.