The impact of anticoagulation therapy after elective percutaneous coronary intervention on prognosis in patients with non-ST-segment elevation acute coronary syndrome

TUO Xiao-dan; LI Dan-dan; YU Ya-ni; CHEN Yun-dai

doi:10.3969/j.issn.1672-5301.2023.12.006

Abstract：Objective To investigate the impact of anticoagulation therapy after non-emergency percutaneous coronary intervention(PCI)on the short-term and long-term prognosis of non-ST-segment elevation acute coronary syndrome(NSTE-ACS)patients.Methods The Real World Study(REFOCAS)of fondaparinux applied to patients with non-ST-segment elevation acute coronary syndrome was a multicenter,prospective,and practical clinical study.From July 2019 to July 2021,a total of 8,066 adult patients who underwent non-emergency PCI treatment were selected from 88 hospitals nationwide.This study included NSTE-ACS patients who underwent non-emergency PCI in the REFOCAS study.The patients received anticoagulation with fondaparinux and low molecular weight heparin(LMWH)in a 2∶1 order.They were divided into the post-PCI anticoagulation group and non post-PCI anticoagulation group based on whether they received anticoagulation treatment after PCI.The post-PCI anticoagulation group received anticoagulation with fondaparinux(2.5 mg/d)or LMWH(1 mg/kg,twice a day)for 2-8 days or until discharge.The patients were followed up for 30 and 180 days to record the occurrence of NACCE(including all cause death,reinfarction,non fatal stroke and BARC≥2 type bleeding)and MACE(including all cause death,reinfarction,non fatal stroke).875 pairs of the patients were matched using propensity score matching(PSM)method,and Kaplan-Meier survival analysis was used to compare the short-term and long-term prognosis differences between the two groups before and after matching.Multivariate Cox regression analysis was used to analyze the impact of post-PCI anticoagulation treatment on prognosis.Finally,multivariate Cox regression analysis was performed in each subgroup.Results The final inclusion comprised 3,293 NSTE-ACS patients who underwent non-emergency PCI and completed a 6-month follow-up.There were 2212(67.2%)patients in the post-PCI anticoagulation group and 1081(32.8%)patients in the non post-PCI anticoagulation group.There were 875 pairs of patients matched using the propensity score matching method,and the baseline characteristics and prognosis of the two groups were analyzed.After matching,the baseline characteristics of the two groups were found to be comparable(P<0.05).Compared with the non post-PCI anticoagulation group,the incidence of 30 days NACCE decreased[56(2.5%)vs.55(5.1%),P<0.001]and MACE,BARC≥2 type bleeding,and stroke events in the hospital and 30 days were also lower(all P<0.05)in the post-PCI anticoagulation group,while there was no statistically significant difference in reinfarction and all cause death events(P>0.05).The incidence of NACCE,BARC≥2 type bleeding and reinfarction events decreased in the post-PCI anticoagulation group in 180 days(all P<0.05),while there was no statistically significant difference in the incidence of MACE,all cause death and stroke(all P>0.05).After PSM,the risk of 30-day NACCE[26(3.0%)vs.44(5.0%),P=0.028],the incidences of NACCE in the hospital and 180 daysand BARC≥2 type bleeding events in 180 days decreased(all P<0.05)in the post-PCI anticoagulation group.Multivariate Cox regression analysis showed that post-PCI anticoagulation was an independent protective factor for hospital NACCE and MACE,30 days NACCE,MACE,and BARC≥2 bleeding,as well as 180 days NACCE and BARC≥2 bleeding.The subgroup analysis suggested that post-PCI use of fondaparinux reduced the risk of NACCE in hospital and 180 days NACCE compared to the non post-PCI anticoagulation group(P<0.05).Conclusions Post-PCI anticoagulation therapy can effectively reduce the risk of in-hospital,30 days and 180 days NACCE in NSTE-ACS patients undergoing non-emergency PCI,and it also has a positive effect on reducing BARC≥2 type bleeding events.