Outcomes and Prognostic Impact of Prophylactic Oral Anticoagulation in Anterior ST‐Segment Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction

• Published in: Journal of the American Heart Association 2017-07, Vol.6 (7), p.n/a
• Main Authors: Shavadia, Jay S., Youngson, Erik, Bainey, Kevin R., Bakal, Jeffrey, Welsh, Robert C.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Alberta; Anterior Wall Myocardial Infarction - diagnosis; Anterior Wall Myocardial Infarction - drug therapy; Anterior Wall Myocardial Infarction - mortality; Anterior Wall Myocardial Infarction - physiopathology; anticoagulant; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Chi-Square Distribution; Female; Hemorrhage - chemically induced; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Original Research; Propensity Score; Registries; Risk Factors; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - drug therapy; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - physiopathology; Stroke - diagnosis; Stroke - mortality; Stroke - prevention & control; stroke prevention; Stroke Volume; systolic dysfunction; Thromboembolism - diagnosis; Thromboembolism - mortality; Thromboembolism - prevention & control; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - drug therapy; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; Warfarin - administration & dosage; Warfarin - adverse effects
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.117.006054

Background The contemporary role of prophylactic anticoagulation following extensive anterior wall ST‐segment myocardial infarction (STEMI) is unclear. Methods and Results We evaluated anterior STEMI patients with left ventricle dysfunction (left ventricular ejection fraction ≤40%) (“high risk”), categorized by prophylactic warfarin use, within a regional STEMI. Patients with pre‐existing atrial fibrillation were excluded. The primary outcome was an adjusted (for Global Registry of Acute Coronary Events risk score) 1‐year composite of recurrent ischemia, stroke/transient ischemic attack/systemic embolism, or all‐cause death. Of the 2032 STEMI admissions, 436 (21.5%) were high risk. After excluding 19 (4.4%) patients with definite left ventricle thrombus and 21 (4.8%) in‐hospital deaths (2 had left ventricle thrombus), prophylactic warfarin was utilized in 236/398 (59.3%) high‐risk survivors. Prescriptions were comparable across sex, but recipients were on average younger (58.5 years versus 64.0 years, P