Key result
Atrial fibrillation was independently associated with a significantly increased risk of 12-month composite adverse cardiovascular events in patients undergoing coronary stenting (RR 5.732).
Why the study?
Does the presence of atrial fibrillation worsen the 12-month prognosis in patients undergoing coronary stenting?
Cohort (n=276)
No
Does the presence of atrial fibrillation worsen the 12-month prognosis in patients undergoing coronary stenting?
Relative Risk: 5.732 (95% CI 1.786–18.396)
Absolute Event Rate: 32.7% vs 16.9%
p-value: p=0.003
In real-world practice, guideline-recommended oral anticoagulation is vastly underutilized in patients with atrial fibrillation undergoing coronary stenting, and these patients face a significantly higher risk of adverse cardiovascular events compared to those without atrial fibrillation.
AF may identify higher-risk stenting patients for closer surveillance; leaves open whether targeted interventions reduce events.
BACKGROUND: It is currently believed that triple oral antithrombotic therapy in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI) should be recommended if there are no contraindications. However, selecting triple therapy for AF patients undergoing PCI is still challenging when bleeding risk is considered. This study aimed to investigate the current use of oral anticoagulants (Vitamin K antagonists [VKA]) and perform prognostic analysis in real-world patients with AF undergoing coronary stenting. METHODS: A total of 276 consecutive coronary artery disease (CAD) patients with or without AF undergoing coronary stenting were retrospectively evaluated and analyzed. The univariate and multivariate analyses were conducted to explore the current use of VKA and prognosis of patients with AF undergoing coronary stenting. The primary end-point was composite of all-cause death, nonfatal recurrent myocardial infarction, stroke, serious bleeding events, unplanned repeat revascularization, and worsening heart failure at 12-month follow-up after coronary stenting. RESULTS: AF patients undergoing coronary stenting have more clinical concomitant diseases. Only 9.0% AF patients after coronary stenting received triple antithrombotic therapy (VKA, aspirin, and clopidogrel) at discharge. AF was independently associated with increased risk of the 12-month composite end-points (relative risk = 5.732, 95% confidence interval 1.786-18.396, P = 0.003). CONCLUSIONS: In real-life AF patients undergoing coronary stenting, guideline-recommended VKA was less used. AF patients had adjusted worse prognosis during 12-month follow-up after discharge. It is of utmost importance to improve the current status of oral anticoagulants use.
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Zhai et al. (2017) conducted a cohort in Coronary artery disease undergoing coronary stenting (n=276). Atrial fibrillation vs. No atrial fibrillation was evaluated on Composite of all-cause death, nonfatal recurrent myocardial infarction, stroke, serious bleeding events, unplanned repeat revascularization, and worsening heart failure (RR 5.732, 95% CI 1.786-18.396, p=0.003). Atrial fibrillation was independently associated with a significantly increased risk of 12-month composite adverse cardiovascular events in patients undergoing coronary stenting (RR 5.732).
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