The association between prothrombin time-international normalized ratio and long-term mortality in patients with coronary artery disease: a large cohort retrospective study with 44,662 patients

Abstract

Background The association between prothrombin time-international normalized ratio (PT-INR) and long-term prognosis among patients with coronary artery disease (CAD) without atrial fibrillation or anticoagulant therapy was still unclear. We analyzed the association of PT-INR levels and long-term mortality in a large cohort of CAD patients without atrial fibrillation or using of anticoagulant drugs. Methods We obtained data from 44,662 patients who were diagnosed with CAD and had follow-up information from January 2008 to December 2018. The patients were divided into 4 groups (Quartile 1: PT-INR ≤ 0.96; Quartile2: 0.96 < PT-INR ≤ 1.01; Quartile3: 1.01 < PT-INR ≤ 1.06; Quartile4: PT-INR > 1.06). The main endpoint was long-term all-cause death. Kaplan–Meier curve analysis and Cox proportional hazards models were used to investigate the association between quartiles of PT-INR levels and long-term all-cause mortality. Results During a median follow-up of 5.25 years, 5613 (12.57%) patients died. We observed a non-linear shaped association between PT-INR levels and long-term all-cause mortality. Patients in high PT-INR level (Quartile4: PT-INR > 1.06) showed a significantly higher long-term mortality than other groups (Quartile2 or 3 or 4), (Compared with Quartile 1, Quartile 2 [0.96 < PT-INR ≤ 1.01], aHR = 1.00, 95% CI 0.91–1.00, P = 0.99; Quartile 3 [1.01 < PT-INR ≤ 1.06], aHR = 1.10, 95% CI 1.01–1.20, P = 0.03; Quartile 4 [PT-INR > 1.06], aHR = 1.33, 95% CI 1.22–1.45, P < 0.05). Conclusions Our study demonstrates high levels of PT-INR were associated with an increased risk of all-cause mortality.

Age–Bilirubin–International Normalized Ratio (INR)–Creatinine (ABIC) Score, a Potential Prognostic Model for Long-Term Mortality of CAD Patients After PCI

“… 30 As CAD is regularly accompanied by an elevated risk of thrombosis and bleeding, it has been revealed by previous studies that its of great significant relationship between prothrombin time–international normalized ratio (PT-INR) level and CAD processes. 31 , 32 Lower PT-INR levels reflect a higher risk of blood clots, while higher PT-INR levels indicate a higher risk of bleeding. The lower risk of bleeding may help limit the formation of bleeding within the plaque, which further stabilizes the atherosclerotic plaque and reduces the risk of cardiovascular events and death.…”

Association between prothrombin time-international normalized ratio and prognosis of post-cardiac arrest patients: A retrospective cohort study

“…Zheng et al ( 22) illustrated that INR is positively correlated with allcause mortality in patients with sepsis, with an adjusted odds ratio (OR) of 1.86 (95% CI: 1.37-2.52) for in-hospital mortality, and an adjusted HR of 1.47 (95% CI: 1.24-1.74) for 1-year mortality. Among patients with coronary artery disease, an increased risk of all-cause mortality has been found in those with high levels of INR (INR > 1.06) during a median follow-up of 5.25 years (23). Ki-Hong et al (24) also reported that prothrombin time-INR prolongation was associated with poor in-hospital survival (adjusted OR = 0.28; 95% CI = 0.11-0.69) in adult out-of-hospital CA with cardiac etiology.…”