BackgroundChronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non‐ST‐elevation myocardial infarction (NSTEMI).AimsTo evaluate the in‐hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation.MethodsUsing the National Inpatient Sample (NIS) years 2016–2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD‐10) appropriate codes. The primary outcome was all‐cause in‐hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient‐level and hospital‐level factors.ResultsAmong 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in‐hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65−0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88−1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03−1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76−0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41−0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: −0.8 days, 95% CI: −0.86 to −0.75, p < 0.001) and (aMD: $−19,340, 95% CI: −20,692 to −17,988, p < 0.001).ConclusionsAmong patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in‐hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.

中文翻译：

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非 ST 段抬高型心肌梗死患者长期抗凝治疗的结果：来自全国住院患者样本的见解


背景慢性全身抗凝治疗在各种血栓栓塞性疾病中普遍存在。抗凝（通常通过肝素产品）也被推荐用于非 ST 段抬高型心肌梗死 (NSTEMI) 的初始治疗。目的是评估长期接受抗凝治疗的 NSTEMI 患者的住院结局。方法使用全国住院患者样本（ NIS）2016-2020 年，使用适当的国际疾病分类第 10 版 (ICD-10) 适当代码来识别 NSTEMI 患者和长期抗凝治疗的患者。主要结局是全因住院死亡率，次要结局包括大出血、缺血性脑血管意外（CVA）、早期经皮冠状动脉介入治疗（PCI）（即入院24小时内）、冠状动脉搭桥术（CABG）住院期间、住院时间 (LOS) 和总费用。调整患者层面和医院层面的因素后，进行多变量逻辑回归或线性回归分析。结果在 2,251,914 名成年 NSTEMI 患者中，190,540 名（8.5%）正在接受长期抗凝治疗。长期抗凝治疗与较低的院内死亡率相关（调整后比值比 [aOR]：0.69，95% 置信区间 [CI]：0.65−0.73，p < 0.001）。大出血（aOR：0.95，95% CI：0.88−1.0，p = 0.15）或缺血性 CVA（aOR：0.23，95% CI：0.03−1.69，p = 0.15）没有显着差异。长期抗凝治疗与早期 PCI（aOR：0.78，95% CI：0.76−0.80，p < 0.001）和 CABG（aOR：0.43，95% CI：0.41−0.45，p < 0.001）发生率较低相关。长期抗凝也与 LOS 和总费用降低相关（调整后平均差 [aMD]：-0.8 天，95% CI：-0.86 至 -0.75，p < 0.001）和（aMD：$-19,340，95% CI：-20,692 至 -17,988，p < 0.001）。 结论 在因 NSTEMI 入院的患者中，长期抗凝治疗使用与较低的院内死亡率、LOS 和总费用相关，而大出血的发生率没有差异。