Impact of atrial fibrillation on clinical outcomes among patients with coronary artery disease undergoing revascularisation with drug-eluting stents.

Abstract

AIMS:

Coronary artery disease (CAD) and atrial fibrillation (AF) are major determinants of morbidity and mortality. A combined treatment with antiplatelet agents and vitamin K antagonists limits the risk of stent thrombosis and stroke while increasing the rate of bleeding. The objective of this study was to investigate the impact of atrial fibrillation (AF) on long-term clinical outcomes in patients with CAD undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

METHODS AND RESULTS:

Among 6,308 consecutive patients undergoing PCI with DES between 2002 and 2009, 323 (5.3%) patients were diagnosed with AF. We compared clinical outcomes between patients with and those without AF throughout four years. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), ischaemic stroke, and BARC bleeding type 3b/3c/5a/5b. In adjusted analyses, the primary composite endpoint was more frequent among patients with AF (HR 1.59, 95% CI 1.26-2.00; p<0.001). Differences were driven by an increased risk of all-cause mortality (HR 1.67, 95% CI 1.27-2.20; p=0.003), ischaemic stroke (HR 3.09, 95% CI 1.45-6.56; p=0.003), and intracranial bleeding (HR 4.28, 95% CI 1.36-13.48; p=0.013). We observed a gradient of risk among patients with higher CHA2DS2-VASc scores and modified outpatient bleeding risk index.

CONCLUSIONS:

Among patients with CAD undergoing revascularisation with DES, AF confers an increased risk of all-cause mortality, ischaemic stroke, and intracranial bleeding. The hazard imposed by AF correlates with the CHA2DS2-VASc score.

• Authors: Thomas Pilgrim, Bindu Kalesan, Thomas Zanchin, Cédric Pulver, Simon Jung, Heinrich Mattle, Thierry Carrel, Aris Moschovitis, Stefan Stortecky, Peter Wenaweser, Giulio G Stefanini, Lorenz Räber, Bernhard Meier, Peter Jüni, Stephan Windecker
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 8 Issue 9 Pg. 1061-71 (Jan 22 2013) ISSN: 1969-6213 [Electronic] France
• PMID: 23339812 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Aged, 80 and over
• Atrial Fibrillation (complications, epidemiology)
• Comorbidity
• Coronary Artery Disease (epidemiology, therapy)
• Drug-Eluting Stents
• Female
• Follow-Up Studies
• Humans
• Incidence
• Intracranial Hemorrhages (epidemiology)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (epidemiology)
• Percutaneous Coronary Intervention (methods)
• Prospective Studies
• Retrospective Studies
• Risk Factors
• Stroke (epidemiology)
• Treatment Outcome