title: Complex Disease, Partial Revascularization, and Adverse Outcomes in Patients Treated With Long-Term Warfarin Therapy Who Underwent Percutaneous Coronary Intervention.
abstract: Patients treated with warfarin who undergo percutaneous coronary intervention (PCI) present a difficult therapeutic problem. Their baseline demographics, procedural characteristics, and 12-month outcomes are poorly defined. We conducted a retrospective analysis of all patients who underwent PCI at a major UK Cardiac Center from 2012 to 2013. Of the 2,675 patients who underwent PCI, 155 were on long-term warfarin treatment (5.8%). Patients on warfarin were older and more likely to have significant co-morbidity than those not on warfarin. The modified Mehran bleed score was higher in patients treated with warfarin versus those not treated (19.0 ± 5.8 vs 15.4 ± 8.0, p = 0.004). Baseline SYNTAX scores were higher in the patients treated with warfarin (18.5 ± 9.1 vs 12.4 ± 3.8, p = 0.0006) as were residual SYNTAX scores (8.3 ± 1.1 vs 3.8 ± 5.9, p = 0.001). Bare metal stents were more frequently used in warfarin-treated patients than those not treated (44.8% vs 26.3%, p <0.0001). Antiplatelet monotherapy was prescribed after PCI in 14.4% of patients treated with warfarin and 0.7% of non-warfarin (p <0.0001), whereas average dual anti-platelet therapy duration was also significantly shorter (4.3 vs 10.7 months, p <0.0001). At 1-year follow-up, target-vessel revascularization (6.5% vs 3.3%, p <0.05), stent thrombosis (5.0% vs 2.6%, p = 0.14), death (10.1% vs 4.6%, p <0.01), and target-vessel revascularization/stent thrombosis/death (21.6% vs 10.5%, p = 0.004) were all more common in the warfarin cohort. In conclusion, patients treated with warfarin who need PCI are a complex cohort, more likely to receive incomplete revascularization, less intense, and shorter durations of antiplatelet therapy, and have adverse 1-year outcomes. More trials of both current DES and newer DES technologies in warfarin-treated patients are needed.
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Khaled
authors.initials: K
authors.lastname: Yazji
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Sorayya
authors.initials: S
authors.lastname: Kakhi
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Ossei-Gerning
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Anirban
authors.initials: A
authors.lastname: Choudhury
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Anderson
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. Electronic address: tim.kinnaird2@wales.nhs.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin