Synergic impact of oral anticoagulation control and renal function in determining major adverse events in atrial fibrillation patients undergoing percutaneous coronary intervention : insights from the AFCAS registry
Articolo
Data di Pubblicazione:
2017
Citazione:
Synergic impact of oral anticoagulation control and renal function in determining major adverse events in atrial fibrillation patients undergoing percutaneous coronary intervention : insights from the AFCAS registry / M. Proietti, K.E.J. Airaksinen, A. Rubboli, A. Schlitt, T. Kiviniemi, P.P. Karjalainen, G.Y.H. Lip. - In: CLINICAL RESEARCH IN CARDIOLOGY. - ISSN 1861-0684. - 106:6(2017 Jun), pp. 420-427. [10.1007/s00392-016-1071-0]
Abstract:
BACKGROUND:
In patients with atrial fibrillation (AF), quality of oral anticoagulation control as well as impaired renal function are associated with adverse outcomes. Our objective was to analyze if there was a synergistic impact of these factors in determining adverse outcomes in AF patients undergoing percutaneous coronary intervention and stent (PCI-S).
METHODS:
Post-hoc analysis from the Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry. Poor oral anticoagulation control was defined as time in therapeutic range (TTR) <65%, while impaired renal function as creatinine clearance (CrCl) <60 ml/min.
RESULTS:
Of the whole cohort, 448 were eligible for this post-hoc analysis. Of these, 27.9% had TTR <65%only (Group I), 19.2% had CrCl <60 ml/min only (Group II), while 13.8% had both conditions (Group III). At follow-up, patients in Group III had a higher rate of major adverse cardiovascular and cerebrovascular events (MACCE) (p = 0.007), while patients in Groups I and III had higher rates of major bleeding. Kaplan-Meier analyses showed that patients in Group III had higher risk for MACCE (LogRank: 14.406, p = 0.003), while Group I and Group III patients had higher risk for major bleeding (LogRank: 12.290, p = 0.006). On Cox regression, presence of both conditions independently increased MACCE risk (p = 0.001), while TTR <65% alone and the presence of both conditions were independently associated with major bleeding (p = 0.004 and p = 0.028, respectively).
CONCLUSIONS:
There was a synergic impact of oral anticoagulation control and renal function in determining major adverse events in AF patients undergoing PCI-S. Use of poor anticoagulation control and impaired renal function in combination would help identify AF patients undergoing PCI-S at risk for MACCE and/or major bleeding.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Atrial fibrillation; Outcomes; Percutaneous coronary intervention; Quality of anticoagulation control; Renal impairment; Cardiology and Cardiovascular Medicine
Elenco autori:
M. Proietti, K.E.J. Airaksinen, A. Rubboli, A. Schlitt, T. Kiviniemi, P.P. Karjalainen, G.Y.H. Lip
Link alla scheda completa: