Abstract
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.
Keywords
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Article info
Publication history
Published online: April 22, 2013
Accepted:
March 17,
2013
Received in revised form:
February 5,
2013
Received:
November 10,
2012
Footnotes
☆ClinicalTrials.gov identifier: NCT00438919.
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
