PROGRESSION OF THE CULPRIT LESION IN UNSTABLE CORONARY-ARTERY DISEASEWITH WARFARIN AND ASPIRIN VERSUS ASPIRIN ALONE - PRELIMINARY-STUDY

Objectives, This study assessed whether combination therapy with aspir in and warfarin for 10 weeks reduces the risk of progression or reoccl usion of the unstable coronary artery lesion, Background, Reocclusion of the culprit coronary artery occurs in up to one third of patients d uring the 3 months after myocardial infarction (MI) or unstable angina and is associated with increased morbidity and mortality, Methods, Fi fty-seven patients presenting with unstable angina or MI who had an id entifiable culprit lesion at coronary angiography were randomized in d ouble-blind manner to receive warfarin (target international normalize d ratio [INR] 2.0 to 2.5) or placebo in addition to aspirin (150 mg da ily), Changes in the culprit lesion were assessed by quantitative angi ography in 50 patients after 10 weeks of therapy or after a clinical e vent, Progression of the culprit lesion was defined as a decrease in m inimal lumen diameter >0.4 mm or a new total occlusion. Regression was defined as an increase in minimal lumen diameter >0.4 mm, Results, In subjects randomized to receive warfarin, the culprit lesion was less likely to progress (1 [4%] vs, 8 [33%]) and more likely to regress (5[ 19%] vs, 2[9%]) than in subjects receiving placebo (p = 0.02), Recurre nt MI or a new occlusion at angiography occurred in 2 (7%) of 29 patie nts receiving warfarin versus 11 (39%) of 28 patients receiving placeb o (p = 0.005), Conclusions, In patients with an acute coronary syndrom e, combined therapy with aspirin and warfarin with a target INR of 2.0 to 2.5 for 10 weeks reduces the risk of progression or reocclusion of the culprit coronary lesion. (C) 1997 by the American College of Card iology.