THE INTERPLAY OF ANTICOAGULATION AND THORACIC AORTA CALCIFICATION IN PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROME

Abstract

Objective: Patients under haemodialysis have increased vascular calcification burden especially that is seems to be upregulated when treated with Vitamin K antagonists (VKA). We sought to investigate the association of anticoagulation and thoracic aorta calcification (TAC) in patients with ACS. Design and method: Two hundred patients admitted with ACS were included in the study. Type of anticoagulant therapy and the extent of TAC were recorded for every patient. Anticoagulants were divided into two groups, VKA and non-VKA anticoagulants. The extent of TAC on a postero-anterior plain chest X-ray was divided into four grades 0 to 3. Lower and higher TAC were categorized as grade 0 to 1 and 2 to 3 respectively. Results: Twenty-nine (15%) patients at admission were on anticoagulants. Seventeen patients (9%) were treated with VKA and 12 patients (6%) with non-VKA anticoagulants. Patients with higher grade of TAC more often had history of heart failure (p < 0.001), chronic kidney disease (p < 0.001) and atrial fibrillation (p = 0.006). Age and history of chronic kidney disease predicted higher TAC burden (Odds ratio [OR] = 1.07, 95% Confidence intervals [CI] 1.03 to 1.10, p < 0.001 and OR = 6.07, 95% CI 2.35 to 15.67, p < 0.001, respectively). Patients treated with VKA had higher TAC grade after adjustment for age, gender and chronic kidney disease. (OR = 3.64, 95% CI 1.08 to 12.20, p = 0.037). On the other hand, there was a non-statistically significant trend for reduced TAC burden in patients treated with non-VKA anticoagulants (OR = 0.24, 95% CI 0.04 to 1.47, p = 0.12). Conclusions: Our study shows that patients with ACS treated with VKA have higher grade TAC, while patients treated with non-VKA anticoagulants seem to have lower grade TAC.