Key result
Among patients with nonvalvular atrial fibrillation, comorbid coronary artery disease was associated with lower use of oral anticoagulant therapy (66.1% vs 74.4%; P=0.01).
Why the study?
What is the prevalence of coronary artery disease and the pattern of antithrombotic therapy in outpatients with nonvalvular atrial fibrillation?
Cross-Sectional (n=6,264)
Yes
What is the prevalence of coronary artery disease and the pattern of antithrombotic therapy in outpatients with nonvalvular atrial fibrillation?
In a real-world Turkish cohort, nearly 30% of NVAF patients had concomitant CAD, and despite having higher stroke risk scores, they were paradoxically less likely to receive oral anticoagulation compared to those without CAD.
NVAF patients with CAD may receive less OAC despite higher stroke risk; Level 4 data leave open whether targeted strategies improve outcomes.
BACKGROUND: Nonvalvular atrial fibrillation (NVAF) frequently coexists with coronary artery disease (CAD). However, the optimal antithrombotic strategy for patients with concomitant CAD and NVAF is controversial. The aim of this study is to assess the prevalence of CAD with NVAF and to determine antithrombotic treatment options in patients with or without a history of CAD. METHODS: ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES study) was a cross-sectional, multicenter, nationwide observational study carried out in NVAF patients. We studied the clinical data of 6264 Turkish patients participating in the RAMSES study. Demographic properties and antithrombotic therapies were recorded and compared between patients with and without CAD. RESULTS: CAD was present in 1828 (29.2%) of patients with NVAF. Most of the NVAF patients with CAD were men (58%) and comorbid diseases were significantly more common in patients with CAD. Although patients with CAD had higher CHA2DS2VASc scores than those without disease (4.1±1.5 vs. 2.9±1.5; P=0.001), they had lower use of oral anticoagulant (OAC) therapy (66.1 vs. 74.4%, P=0.01). Among OAC drugs, warfarin was the preferred medication in patients with CAD (35.4 vs. 30.6%, P=0.01), whereas nonvitamin K antagonist oral anticoagulants were preferred in patients without CAD (40 vs. 34.3%, P=0.01). Patients with CAD required nearly three-fold higher antiplatelet treatment compared with patients without CAD (57.8 vs. 21.4%, P<0.001). CONCLUSION: CAD affects nearly one-third of patients with NVAF in a real-world setting. Although they merit more aggressive therapy, patients with CAD and NVAF were less likely to receive OAC therapy.
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Doğan et al. (2016) conducted a cross-sectional in Nonvalvular atrial fibrillation (NVAF) (n=6,264). Coronary artery disease (CAD) vs. No coronary artery disease was evaluated on Use of oral anticoagulant (OAC) therapy (p=0.01). Among patients with nonvalvular atrial fibrillation, comorbid coronary artery disease was associated with lower use of oral anticoagulant therapy (66.1% vs 74.4%; P=0.01).
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