Atrial fibrillation, intra-ventricular thrombus, and other anticoagulant indications relationship with adverse outcomes in acute anterior myocardial infarction patients. Issue 4 (October 2018)

• Record Type: Journal Article
• Authors: Bourezg, Asma; Bochaton, Thomas; Mewton, Nathan; Morel, Olivier; Cayla, Guillaume; Rioufol, Gilles; Bonnefoy-Cudraz, Eric; Guerin, Patrice; Elbaz, Meyer; Boussaha, Inesse; Amaz, Camille; Angoulvant, Denis; Ovize, Michel
• Is Part Of: Journal of cardiology. Volume 72:Issue 4(2018)
• Page Start: 277
• Page End: 283
• Publication Date: 2018-10
• Subjects: Anterior myocardial infarction -- Heart failure -- Atrial arrhythmia -- Left ventricular thrombus; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2018.03.008
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: 16% patients have AF or ventricular thrombus following anterior myocardial infarction. AF and VT are independent predictors of adverse events following anterior AMI. Anticoagulant combined with APT did not appear to change outcomes at one year. Abstract: Background: The aim of this study was to assess the predictive value of atrial fibrillation (AF), left ventricular thrombus (LVT), and other oral anticoagulant (OAC) indications on 1-year major adverse cardio-cerebrovascular events (MACCE) and bleeding in acute anterior ST-elevated myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Methods: Our study population included 969 anterior STEMI patients referred for PPCI from the prospective multicenter CIRCUS trial. Patients with a formal indication of OAC within the first year were compared to those without indication. Results: A total of 161 (16.6%) patients were eligible for OAC after anterior STEMI mainly for AF (51.5%) and LVT (39.7%). This group had a higher morbidity profile despite similar reperfusion settings – 67% of them were treated with OAC. At 1 year, OAC indication was associated with a significant increase in MACCE rate [OR 3.37 95% CI (2.36;4.82) p < 0.001] as well as bleeding [OR = 1.96 95% CI (1.09;3.50) p = 0.02]. After adjustment for principal confounders, OAC indication remained strongly associated with MACCE [HR 3.40 (1.26;9.14) p = 0.016]. Conclusions: In a prospective cohort of anterior STEMI, AF, LVT, and other OAC indications were present upon discharge in 1 patient out of 6 and only two thirds were treated with OAC. OAC indication was independently associated with an increased risk of MACCE and bleeding at one year.