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Jung J, Seo Y, Her SH, Lee JH, Lee K, Yoo KD, Moon KW, Moon D, Lee SN, Jang WY, Choi IJ, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ. Prognostic Impact of Atrial Fibrillation in Patients with Heavily Calcified Coronary Artery Disease Receiving Rotational Atherectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1808. [PMID: 37893526 PMCID: PMC10608542 DOI: 10.3390/medicina59101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/02/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Although both rotational atherectomy (RA) and atrial fibrillation (AF) have a high thrombotic risk, there have been no previous studies on the prognostic impact of AF in patients who undergo percutaneous coronary intervention (PCI) using RA. Thus, the aim of the present study was to determine the prognostic impact of AF in patients undergoing PCI using RA. Materials and Methods: A total of 540 patients who received PCI using RA were enrolled between January 2010 and October 2019. Patients were divided into AF and sinus rhythm groups according to the presence of AF. The primary endpoint was net adverse clinical events (NACEs) defined as a composite outcome of all-cause death, myocardial infarction, target vessel revascularization, cerebrovascular accident, or total bleeding. Results: Although in-hospital adverse events showed no difference between those with AF and those without AF (in-hospital events, 54 (11.0%) vs. 6 (12.2%), p = 0.791), AF was strongly associated with an increased risk of NACE at 3 years (NACE: hazard ratio, 1.880; 95% confidence interval, 1.096-3.227; p = 0.022). Conclusions: AF in patients who underwent PCI using RA was strongly associated with poor clinical outcomes. Thus, more attention should be paid to thrombotic and bleeding risks.
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Affiliation(s)
- Jin Jung
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Yeonjoo Seo
- Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea;
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea
| | - Kyusup Lee
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Republic of Korea;
| | - Ki-Dong Yoo
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Keon-Woong Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Donggyu Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Su-Nam Lee
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Won-Young Jang
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Ik-Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea;
| | - Jang-Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea;
| | - Sang-Rok Lee
- Department of Cardiology, Chonbuk National University Hospital, Jeonju 54907, Republic of Korea;
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Kyeong-Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan 54538, Republic of Korea;
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Republic of Korea;
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Takeda T, Dohke T, Ueno Y, Mastui T, Fujii M, Takayama T, Dochi K, Miyamoto A, Mabuchi H, Wada A. Clinical utility of the BIWACO score for patients with atrial fibrillation after percutaneous coronary intervention. Heart Vessels 2023; 38:96-105. [PMID: 35871206 PMCID: PMC9810676 DOI: 10.1007/s00380-022-02128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
No predictive clinical risk scores for net adverse clinical events (NACE) have been developed for patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). We evaluated NACE to develop clinically applicable risk-stratification scores in the Bleeding and thrombotic risk evaluation In patients With Atrial fibrillation under COronary intervention (BIWACO) study, a multicenter survey which has enrolled a total of 7837 patients. We also investigated the current status and time trends for the use of antithrombotic drugs. A total of 188 AF patients who had received PCI were examined. At discharge, 65% of patients were prescribed a triple therapy (TT), 6% were prescribed a dual therapy, the remaining 29% of patients received dual-antiplatelet therapy. After 4 years, the fraction of patients continuing TT decreased by 15%, whereas oral anticoagulant alone was only 2% of patients. NACE developed in 20% of patients, resulting in death in 5% of the patients, and the remaining 13% experienced bleeding events. We developed risk scores for NACE comprising the five strongest predictive items, which we designated BIWACO scores. The area under the curve was 0.774 for NACE. Our study explored the differences in treatment practices and guideline recommendations for antithrombotic therapy. We concluded that our BIWACO score is useful for predicting clinical outcomes in AF-patients after PCI.
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Affiliation(s)
- Teruki Takeda
- grid.513109.fDivision of Cardiology, Koto Memorial Hospital, Higashiomi-shi, Japan
| | - Tomohiro Dohke
- Division of Cardiology, Kohka Public Hospital, Koka-shi, Japan
| | - Yoshiki Ueno
- Division of Cardiology, Nagahama Red Cross Hospital, Nagahama-shi, Japan
| | - Toshiki Mastui
- Division of Cardiology, Shiga Hospital JCHO, Otsu-shi, Japan
| | - Masanori Fujii
- Department of Cardiology, Omi Medical Center, 1660 Yabase, Kusatsu-shi, Shiga 525-8585 Japan
| | | | - Kenichi Dochi
- Division of Cardiology, Nagahama Red Cross Hospital, Nagahama-shi, Japan
| | - Akashi Miyamoto
- Division of Cardiology, Shiga Hospital JCHO, Otsu-shi, Japan
| | - Hiroshi Mabuchi
- grid.513109.fDivision of Cardiology, Koto Memorial Hospital, Higashiomi-shi, Japan
| | - Atsuyuki Wada
- Department of Cardiology, Omi Medical Center, 1660 Yabase, Kusatsu-shi, Shiga 525-8585 Japan
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Zheng JY, Cao Y, Li DT, Qiu YG, Zhao L, Xu ZM, Huang YX, Hong ZB, Li TC, Tang YD, Guo CJ, Ma ZM, Wu YQ, Chen Y. Predictive models for adverse clinical outcomes in Chinese patients with atrial fibrillation undergoing percutaneous coronary intervention with stenting. Acta Cardiol 2022; 77:360-365. [PMID: 34353224 DOI: 10.1080/00015385.2021.1950367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate predictors for adverse cardiovascular outcomes in patients with atrial fibrillation (AF) undergoing coronary stenting. METHODS We retrospectively recruited consecutive patients with previously documented non-valvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. Major adverse cardiac/cerebrovascular events (MACCE) were a composite of all-cause death, non-fatal myocardial infarction, repeat revascularization, and ischaemic stroke/systemic thromboembolism (IS/STE). Major bleeding referred to grade 2 or higher of Bleeding Academic Research Consortium criteria. RESULTS A total of 2394 patients (men: 72.3% vs. women: 27.7%, median age: 67 years) were included. The CHA2DS2-VASc and HAS-BLED were 3.6 ± 1.6 and 1.9 ± 0.7, respectively. The median follow-up duration was 36.2 months. There were 230 (9.6%) deaths, 96 (4.0%) IS/STE, 426 (17.8%) MACCE, and 72 (3.0%) major bleeding. Multivariate Cox regression yielded predictive models for (1) all-cause death: diabetes, prior myocardial infarction, chronic kidney disease (CKD), ST-segment elevation myocardial infarction (STEMI) at presentation, heart failure, no use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins; (2) IS/STE: advanced age, prior history of ischaemic stroke and intracranial haemorrhage; (3) MACCE: prior history of myocardial infarction and ischaemic stroke, CKD, STEMI, heart failure, and no statin use; (4) major bleeding: prior major bleeding, prior myocardial infarction, CKD and use of oral anticoagulants. CONCLUSION Chinese patients with AF and coronary stenting had high mortality and incidence of MACCE. We compiled separate predictive models for all-cause death, IS/STE, MACCE, and major bleeding.
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Affiliation(s)
- Jian-Yong Zheng
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Yi Cao
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Dong-Tao Li
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Yi-Gang Qiu
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Li Zhao
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Zheng-Ming Xu
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Yi-Xiong Huang
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Zhi-Bo Hong
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Tian-Chang Li
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng-Jun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhi-Min Ma
- Department of Cardiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong-Quan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China
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Sex difference in clinical outcomes of Chinese patients with atrial fibrillation and coronary stenting according to age. Anatol J Cardiol 2020; 25:17-23. [PMID: 33382053 DOI: 10.14744/anatoljcardiol.2020.80930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Sex differences in the clinical outcomes of patients with atrial fibrillation (AF) and coronary stenting should be assessed according to age. METHODS We analyzed the clinical data of all patients with nonvalvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. RESULTS A total of 2,146 patients (71.8% men and 28.2% women) were included in the study. The mean age of the patients was 66.6±9.4 years. Women in this study were older and had higher prevalence of hypertension, diabetes, chronic kidney disease (CKD), and anemia. Smoking history was found to be higher in men, and women were less likely to be current smokers. The mean follow-up duration was 39.7 months. Women younger than 65 years had a remarkably higher mortality (11.2% vs. 5.3%, p=0.012) and a significantly lower rate of repeat revascularization (1.6% vs. 6.3%, p=0.034) than men. Female gender remained an independent predictor for all-cause mortality [hazard ratio (HR)=2.03, 95% confidence interval (CI): 1.09-3.79, p=0.025], along with heart failure (HR=3.64, 95% CI: 2.02-6.57, p<0.001) and CKD (HR=2.46, 95% CI: 1.09-5.57, p=0.031) after multivariate regression analysis. No significant difference was noted between men and women with regard to mortality, ischemic events, and major bleeding in elderly patients. CONCLUSION In Chinese patients younger than 65 years with AF and coronary stenting, female gender was independently associated with increased mortality; men were more likely to receive repeat revascularization possibly due to the current smoking. Whether it was a biological difference or a recognition disparity of the disease between men and women warrants further investigation.
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Triple therapy: A review of antithrombotic treatment for patients with atrial fibrillation undergoing percutaneous coronary intervention. J Cardiol 2018; 73:1-6. [PMID: 30293674 DOI: 10.1016/j.jjcc.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 11/23/2022]
Abstract
In patients with atrial fibrillation (AF), concomitant coronary artery disease is often present, and vice versa. Optimal antithrombotic treatment for patients with AF undergoing percutaneous coronary intervention (PCI) is one of the major concerns in the field of cardiology. Triple therapy, a combination of oral anticoagulant (OAC) plus dual antiplatelet therapy with aspirin and P2Y12 inhibitor, has been used for patients with AF undergoing PCI in recent decades to reduce ischemic events under guideline recommendations. However, triple therapy is well-known to induce severe bleeding events. Recently, the results of several clinical trials have been published, and the latest guidelines recommend that most patients should undergo dual therapy (i.e. OAC plus P2Y12 inhibitor) from the beginning of PCI, or triple therapy only peri-PCI period and immediately shift to dual therapy after hospital discharge. Although these recommendations are useful and appear to be reasonable, no studies have validated this. In addition, there are a number of unresolved issues regarding the antithrombotic treatment for patients with AF undergoing PCI such as risk prediction models and the best combination of OAC with antiplatelet agents, and prospective trials are ongoing. This review article will summarize current evidence and focus on the optimal regimen of antithrombotic treatment for patients with AF undergoing PCI.
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Matsumura-Nakano Y, Shiomi H, Morimoto T, Shizuta S, Yamaji K, Watanabe H, Yoshikawa Y, Taniguchi T, Kawaji T, Natsuaki M, Akasaka T, Hanaoka K, Kadota K, Kozuma K, Tanabe K, Nakagawa Y, Muramatsu T, Morino Y, Ando K, Kimura T. Sex Differences in Long-Term Clinical Outcomes in Patients With Atrial Fibrillation Undergoing Coronary Stent Implantation. Circ J 2018; 82:1754-1762. [PMID: 29593146 DOI: 10.1253/circj.cj-17-1278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with concomitant atrial fibrillation (AF) and coronary stenting are at high risk for both cardiovascular and bleeding events. We aimed to evaluate the influence of sex on long-term clinical outcomes in this patient subset.Methods and Results:We identified 1,450 patients with AF and coronary stenting in a patient-level pooled database from 3 Japanese studies, and compared 3-year clinical outcomes between men and women (n=1,075, and n=375, respectively). The cumulative 3-year incidence of all-cause death was significantly higher in women than in men (26.5% vs. 17.2%, log-rank P<0.001), although after adjusting for confounders, the excess mortality risk of women relative to men was no longer significant (hazard ratio (HR): 1.12, 95% confidence interval (CI): 0.85-1.46, P=0.42). There were no significant differences in the adjusted 3-year risks for myocardial infarction or stroke between men and women (HR: 1.25, 95% CI: 0.62-2.40, P=0.52, and HR: 1.15, 95% CI: 0.75-1.74, P=0.52, respectively). However, both the cumulative 3-year incidence of and adjusted risk for major bleeding were significantly higher in women than in men (17.0% vs. 11.3%, log-rank P=0.002, and HR: 1.47, 95% CI: 1.03-2.07, P=0.03). CONCLUSIONS Among patients with concomitant AF and coronary stenting, there were no significant differences in the adjusted 3-year risks for all-cause death, myocardial infarction, and stroke between men and women. However, women as compared with men were associated with excess adjusted risk for major bleeding.
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Affiliation(s)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Komura Memorial Hospital
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Tetsuma Kawaji
- Department of Cardiovascular Medicine, Mitsubishi Kyoto Hospital
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University Hospital
| | | | | | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | | | | | - Kenji Ando
- Department of Cardiovascular Medicine, Komura Memorial Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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