背景:慢性全身性抗凝治疗对于各种血栓栓塞疾病很普遍。抗凝(通常通过肝素产品)也建议用于非ST段抬高型心肌梗死(NSTEMI)的初始治疗。
目的:评估接受慢性抗凝治疗的NSTEMI患者的院内转归。
方法:使用2016-2020年的全国住院患者样本(NIS),使用适当的国际疾病分类确定NSTEMI患者和慢性抗凝患者。第10版(ICD-10)适当的代码。主要结局是全因住院死亡率,而次要结局包括大出血,缺血性脑血管意外(CVA),早期经皮冠状动脉介入治疗(PCI)(即入院24小时内),住院期间冠状动脉旁路移植术(CABG),停留时间(LOS)和总收费。在调整患者水平和医院水平因素后,进行了多变量逻辑或线性回归分析。
结果:在2,251,914名成人NSTEMI患者中,190,540(8.5%)接受慢性抗凝治疗。慢性抗凝治疗与住院死亡率较低相关(校正比值比[aOR]:0.69,95%置信区间[CI]:0.65-0.73,p<0.001)。大出血(aOR:0.95,95%CI:0.88-1.0,p=0.15)或缺血性CVA(aOR:0.23,95%CI:0.03-1.69,p=0.15)没有显着差异。慢性抗凝治疗与早期PCI(aOR:0.78,95%CI:0.76-0.80,p<0.001)和CABG(aOR:0.43,95%CI:0.41-0.45,p<0.001)的发生率较低相关。慢性抗凝也与LOS和总费用降低相关(调整后的平均差[aMD]:-0.8天,95%CI:-0.86至-0.75,p<0.001)和(aMD:$-19,340,95%CI:-20,692至-17,988,p<0.001)。
结论:在NSTEMI患者中,慢性抗凝治疗与住院死亡率较低相关,LOS,和总费用,大出血的发生率无差异。
BACKGROUND: Chronic 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).
OBJECTIVE: To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation.
METHODS: Using 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.
RESULTS: Among 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).
CONCLUSIONS: Among 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.