TY - JOUR
T1 - Drug eluting stent implantation in patients requiring concomitant vitamin K antagonist therapy. One-year outcome of the worldwide e-SELECT registry
AU - Sabaté, Manel
AU - Brugaletta, Salvatore
AU - Abizaid, Alexandre
AU - Banning, Adrian
AU - Bartorelli, Antonio
AU - Džavík, Vladimír
AU - Ellis, Stephen
AU - Holmes, David
AU - Gao, Runlin
AU - Jeong, Myung Ho
AU - Legrand, Victor
AU - Neumann, Franz Josef
AU - Nyakern, Maria
AU - Spaulding, Christian
AU - Stoll, Hans Peter
AU - Worthley, Stephen
AU - Urban, Philip
PY - 2013/10/3
Y1 - 2013/10/3
N2 - Background Outcome of sirolimus-eluting stent (SES) in patients treated with an antivitamin K (VKA) agent before the PCI procedure is unknown. Methods A total of 7651 patients were selected among 15,147 recipients of SES, included in the worldwide e-SELECT registry, only from those centers which included at least one patient requiring VKA: 296 were pretreated with a VKA agent (VKA group), whereas 7355 patients from the same enrolling medical centers were not (NON-VKA group). The rates of 1) major adverse cardiac events (MACE), including all-cause deaths, myocardial infarction (MI) and target lesion revascularization, 2) stent thrombosis (ST) and 3) major bleeding (MB) in the 2 study groups were compared at 1, 6 and 12 months. Results The patients in VKA group were on average older as compared to those in NON-VKA group (67.7 ± 9.9 vs.62.9 ± 10.7, P < 0.001). The indications for pre-procedural anticoagulation were atrial fibrillation in 177 (59.8%), presence of a prosthetic valve in 21 (7.1%), embolization of cardiac origin in 17 (5.7%), pulmonary embolism or deep vein thrombosis in 17 (5.7%), and miscellaneous diagnoses in 64 (21.6%) patients. At 1 year, the rates of MACE and MB were higher in the VKA vs. The NON-VKA group (8.3% and 3% vs. 5.3% and 1.2%, P < 0.04and P < 0.002, respectively). The 1-year rates of definite and probable ST were remarkably low in both groups (0.38% vs. 1.1%, p = 0.4). Conclusions Selected patients anticoagulated with VKA agent may safely undergo SES implantation. Those patients may receive a variety of APT regimen at the cost of a moderate increased risk of MB.
AB - Background Outcome of sirolimus-eluting stent (SES) in patients treated with an antivitamin K (VKA) agent before the PCI procedure is unknown. Methods A total of 7651 patients were selected among 15,147 recipients of SES, included in the worldwide e-SELECT registry, only from those centers which included at least one patient requiring VKA: 296 were pretreated with a VKA agent (VKA group), whereas 7355 patients from the same enrolling medical centers were not (NON-VKA group). The rates of 1) major adverse cardiac events (MACE), including all-cause deaths, myocardial infarction (MI) and target lesion revascularization, 2) stent thrombosis (ST) and 3) major bleeding (MB) in the 2 study groups were compared at 1, 6 and 12 months. Results The patients in VKA group were on average older as compared to those in NON-VKA group (67.7 ± 9.9 vs.62.9 ± 10.7, P < 0.001). The indications for pre-procedural anticoagulation were atrial fibrillation in 177 (59.8%), presence of a prosthetic valve in 21 (7.1%), embolization of cardiac origin in 17 (5.7%), pulmonary embolism or deep vein thrombosis in 17 (5.7%), and miscellaneous diagnoses in 64 (21.6%) patients. At 1 year, the rates of MACE and MB were higher in the VKA vs. The NON-VKA group (8.3% and 3% vs. 5.3% and 1.2%, P < 0.04and P < 0.002, respectively). The 1-year rates of definite and probable ST were remarkably low in both groups (0.38% vs. 1.1%, p = 0.4). Conclusions Selected patients anticoagulated with VKA agent may safely undergo SES implantation. Those patients may receive a variety of APT regimen at the cost of a moderate increased risk of MB.
KW - Anticoagulation
KW - Antivitamin K therapy
KW - Coronary stent
KW - Drug-eluting stent
KW - Hemorrhagic event
KW - Sirolimus-eluting stent
KW - Stent thrombosis
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U2 - 10.1016/j.ijcard.2013.03.064
DO - 10.1016/j.ijcard.2013.03.064
M3 - Article
C2 - 23602865
AN - SCOPUS:84885650350
SN - 0167-5273
VL - 168
SP - 2522
EP - 2527
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 3
ER -