Is Oral Anticoagulation an Independent Predictor of Mortality in STEMI and High‐Risk NSTEMI Patients After Primary PCI? A Propensity Score‐Matched Retrospective Analysis
TL;DR
Despite higher postdischarge mortality and bleeding, OAC use was not independently associated with mortality after adjustment, emphasising comprehensive risk stratification in this population of patients.
Abstract
Background Managing STEMI and high‐risk NSTEMI‐equivalent patients on chronic oral anticoagulation (OAC) undergoing primary PCI poses competing ischaemic and bleeding risks. Methods This single‐centre retrospective study enrolled 604 consecutive STEMI/high‐risk NSTEMI patients undergoing primary PCI (2012–2023). OAC users (n = 100) were compared with propensity score–matched controls (n = 203). Primary endpoints included all‐cause mortality, bleeding, stroke, recurrent MI and rehospitalisation over a mean 3‐year follow‐up. Results OAC users had a higher prevalence of prior ischaemic stroke/TIA (19% vs. 3%, p < 0.001) and known coronary artery disease (33% vs. 20%, p = 0.015). In‐hospital mortality was comparable (7% vs. 5.9%, p = 0.80). Postdischarge long‐term mortality was significantly higher in OAC users (31% vs. 14.8%, p = 0.001), as were access‐site haematoma (8% vs. 2%, p = 0.02) and minor bleeding (7% vs. 1.5%, p = 0.03). On multivariable Cox regression, OAC use was not an independent mortality predictor (HR 0.81, 95% CI 0.47–1.37, p = 0.43); age, reduced ejection fraction and chronic kidney disease were the principal determinants. Conclusion Despite higher postdischarge mortality and bleeding, OAC use was not independently associated with mortality after adjustment. Comorbidity burden drives prognosis, emphasising comprehensive risk stratification in this population.