Cardiovasc Ther. 2026;2026(1):e1295386. doi: 10.1155/cdr/1295386.
ABSTRACT
BACKGROUND: Managing STEMI and high-risk NSTEMI-equivalent patients on chronic oral anticoagulation (OAC) undergoing primary PCI poses competing ischaemic and bleeding risks.
METHODS: This single-centre retrospective study enrolled 604 consecutive STEMI/high-risk NSTEMI patients undergoing primary PCI (2012-2023). OAC users (n = 100) were compared with propensity score-matched controls (n = 203). Primary endpoints included all-cause mortality, bleeding, stroke, recurrent MI and rehospitalisation over a mean 3-year follow-up.
RESULTS: OAC users had a higher prevalence of prior ischaemic stroke/TIA (19% vs. 3%, p < 0.001) and known coronary artery disease (33% vs. 20%, p = 0.015). In-hospital mortality was comparable (7% vs. 5.9%, p = 0.80). Postdischarge long-term mortality was significantly higher in OAC users (31% vs. 14.8%, p = 0.001), as were access-site haematoma (8% vs. 2%, p = 0.02) and minor bleeding (7% vs. 1.5%, p = 0.03). On multivariable Cox regression, OAC use was not an independent mortality predictor (HR 0.81, 95% CI 0.47-1.37, p = 0.43); age, reduced ejection fraction and chronic kidney disease were the principal determinants.
CONCLUSION: Despite higher postdischarge mortality and bleeding, OAC use was not independently associated with mortality after adjustment. Comorbidity burden drives prognosis, emphasising comprehensive risk stratification in this population.
PMID:42817583 | DOI:10.1155/cdr/1295386