In-hospital management and outcome of patients on warfarin undergoing coronary stent implantation: results of the multicenter, prospective WARfarin and coronary STENTing (WAR-STENT) registry
Andrea Rubboli, Alessandro Sciahbasi, Carlo Briguori, Francesco Saia, Cataldo Palmieri, Luigi Andrea Moroni, Paolo Calabrò, Antonio Maria Leone, Nicoletta Franco, Marco Valgimigli, Elisabetta Varani, Michela Santi, Paola Pasqualini, Alessandro Capecchi, Giacomo Piccalò, Massimo Margheri, Giuseppe di Pasquale, Marcello Galvani, Leonardo Bolognese, Lucio Gonzini, Aldo Pietro Maggioni, WARfarin and coronary STENTing registry, Andrea Rubboli, Giuseppe Di Pasquale, Giuseppe Steffenino, Stefano Mistrorigo, Luigi La Vecchia, Davide D'Andrea, Salvatore Grasso, Stefano Maggiolini, Alessandro Sciahbasi, Ernesto Lioy, Gianluca Caiazzo, Carlo Briguori, Nicoletta Franco, Giancarlo Piovaccari, Eloisa Basile, Antonio M Leone, Annamaria Nicolino, Sharham Moshiri, Stefano Mameli, Luigi Steffanon, Alberto Benassi, Pierpaolo Cannarozzo, Giuseppe Carosio, Paola Pasqualini, Silva Severi, Kenneth Ducci, Leonardo Bolognese, Alessandro Capecchi, Leonardo G Pancaldi, Luigi Vignali, Diego Ardissino, Francesco Saia, Barbara Bordoni, Elisabetta Varani, Massimo Margheri, Giacomo Piccalò, Antonio Mafrici, Paolo Calabrò, Chiara Sordelli, Simona Boarin, Marcello Galvani, Pasquale Catanzariti, Flavio Tartagni, Michela Santi, Stefano Della Casa, Cataldo Palmieri, Francesco Bovenzi, Andrea Rizzi, Claudio Cuccia, Ferdinando Imperadore, Monia Monti, Marco Valgimigli, Paolo Magnavacchi, Michele Dallago, Roberto Bonmassari, Paolo Sbarzaglia, Claudio Cavallini, Enrico Russolillo, Simona Lambertini, Giuseppe Massimo Sangiorgi, Luigi Andrea Moroni, Paolo Rubartelli, Andrea Rubboli, Alessandro Sciahbasi, Carlo Briguori, Francesco Saia, Cataldo Palmieri, Luigi Andrea Moroni, Paolo Calabrò, Antonio Maria Leone, Nicoletta Franco, Marco Valgimigli, Elisabetta Varani, Michela Santi, Paola Pasqualini, Alessandro Capecchi, Giacomo Piccalò, Massimo Margheri, Giuseppe di Pasquale, Marcello Galvani, Leonardo Bolognese, Lucio Gonzini, Aldo Pietro Maggioni, WARfarin and coronary STENTing registry, Andrea Rubboli, Giuseppe Di Pasquale, Giuseppe Steffenino, Stefano Mistrorigo, Luigi La Vecchia, Davide D'Andrea, Salvatore Grasso, Stefano Maggiolini, Alessandro Sciahbasi, Ernesto Lioy, Gianluca Caiazzo, Carlo Briguori, Nicoletta Franco, Giancarlo Piovaccari, Eloisa Basile, Antonio M Leone, Annamaria Nicolino, Sharham Moshiri, Stefano Mameli, Luigi Steffanon, Alberto Benassi, Pierpaolo Cannarozzo, Giuseppe Carosio, Paola Pasqualini, Silva Severi, Kenneth Ducci, Leonardo Bolognese, Alessandro Capecchi, Leonardo G Pancaldi, Luigi Vignali, Diego Ardissino, Francesco Saia, Barbara Bordoni, Elisabetta Varani, Massimo Margheri, Giacomo Piccalò, Antonio Mafrici, Paolo Calabrò, Chiara Sordelli, Simona Boarin, Marcello Galvani, Pasquale Catanzariti, Flavio Tartagni, Michela Santi, Stefano Della Casa, Cataldo Palmieri, Francesco Bovenzi, Andrea Rizzi, Claudio Cuccia, Ferdinando Imperadore, Monia Monti, Marco Valgimigli, Paolo Magnavacchi, Michele Dallago, Roberto Bonmassari, Paolo Sbarzaglia, Claudio Cavallini, Enrico Russolillo, Simona Lambertini, Giuseppe Massimo Sangiorgi, Luigi Andrea Moroni, Paolo Rubartelli
Abstract
The in-hospital management of patients on warfarin undergoing coronary stent implantation (PCI-S) is variable, and the in-hospital outcome incompletely defined. To determine the adherence to the current recommendations, and the incidence of adverse events, we carried out the prospective, multicenter, observational WARfarin and coronary STENTing (WAR-STENT) registry (ClinicalTrials.gov identifier NCT00722319). All consecutive patients on warfarin undergoing PCI-S at 37 Italian centers were enrolled and followed for 12 months. Outcome measures were: major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, need for urgent revascularization, stroke, and venous thromboembolism, and major and minor bleeding. In this paper, we report the in-hospital findings. Out of the 411 patients enrolled, 92% were at non-low (ie, moderate or high) thromboembolic risk. The radial approach and bare-metal stents were used in 61% and 60% of cases, respectively. Drug-eluting stents were essentially reserved to patients with diabetes, which in turn, significantly predicted the implantation of drug-eluting stents (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.29-3.17; P=.002). The in-hospital MACE and major bleeding rates were 2.7% and 2.1%, respectively. At discharge, triple therapy (TT) of warfarin, aspirin, and clopidogrel was prescribed to 76% of patients. Prescription of TT was significantly more frequent in the non-low thromboembolic risk group. Non-low thromboembolic risk, in turn, was a significant predictor of TT prescription (OR, 11.2; 95% CI, 4.83-26.3; P<.0001). In conclusion, real-world warfarin patients undergoing PCI-S are largely managed according to the current recommendations. As a consequence, the risk of in-hospital MACE and major bleedings appears limited and acceptable.
Source: PubMed