1
|
Zhang H, Zheng L, Yang Z, Zhao H, Zhu Y, Ma Y, Wu Z, Qiu W, Zhou Z, Liu Y, Chen Y. Development and Validation of Prognostic Models for Bleeding and Ischemia in Elderly Patients With Comorbid Acute Coronary Syndrome and Atrial Fibrillation. J Am Heart Assoc 2024; 13:e035086. [PMID: 39392148 DOI: 10.1161/jaha.124.035086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/12/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Acute coronary syndrome and atrial fibrillation are common cardiovascular diseases in elderly individuals. Patients with comorbidities face increased risks of bleeding and ischemia; however, there is a lack of prognostic models for quantifying these risks in this special population. METHODS AND RESULTS In this retrospective cohort study, 1851 patients (≥65 years old) with acute coronary syndrome and atrial fibrillation from 2 hospitals in China were included in the development cohort (1252 individuals) and 2 external validation cohorts (284 and 315 individuals). During 1-year follow-up, 96 Bleeding Academic Research Consortium type 3 or 5 bleeding events and 245 thromboembolic events were observed. In the development cohort, the concordance indexes for bleeding at 3, 6, and 12 mo ranged from 0.737 to 0.845 and for ischemia ranged from 0.723 to 0.777. The calibration curve and decision curve analysis indicated adequate calibration and clinical practicability. The concordance indexes varied from 0.679 to 0.809 in the validation cohorts. Subgroup analyses focusing on anticoagulant drugs and antithrombotic therapy were conducted, revealing similar discrimination and calibration. Kaplan-Meier curves demonstrated significant differences (log-rank P<0.001). Additionally, the models outperformed conventional models in concordance indexes, integrated discrimination improvement, and net reclassification improvement. CONCLUSIONS Our study provides 2 robust prognostic models with easily available clinical factors for predicting bleeding and ischemia in elderly patients with acute coronary syndrome and atrial fibrillation. Furthermore, we provide online calculators to facilitate individualized risk evaluation and clinical decision-making. REGISTRATION URL: www.chictr.org.cn/. Unique Identifier: ChiCTR2200067185.
Collapse
Affiliation(s)
- Honghong Zhang
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
| | - Li Zheng
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- School of Medicine Nankai University Tianjin China
| | - Zengao Yang
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- School of Medicine South China University of Technology Guangzhou China
| | - Haijing Zhao
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
| | - Yue Zhu
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
| | - Yuhan Ma
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- School of Medicine Nankai University Tianjin China
| | - Zhengfeng Wu
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
| | - Weize Qiu
- Department of Information, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Shanghai Medical College Fudan University Shanghai China
| | - Yuqi Liu
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
- National Key Laboratory of Kidney Diseases Beijing China
- Department of Cardiology & National Clinical Research Center of Geriatric Disease Beijing China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine Beijing China
| | - Yundai Chen
- Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China
| |
Collapse
|
2
|
Bor WLW, Azzahhafi J, Maio ND, van der Sangen NMR, Verburg A, Rayhi S, Peper J, Chan Pin Yin DRPP, Ten Berg JM. Outcomes of newly diagnosed atrial fibrillation in patients with acute coronary syndromes. EUROINTERVENTION 2024; 20:996-1007. [PMID: 39155759 PMCID: PMC11317829 DOI: 10.4244/eij-d-23-01049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/03/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is frequently accompanied by newly diagnosed atrial fibrillation (AF). AIMS We aimed to compare the risk of major adverse cardiovascular events (MACE) in ACS patients presenting with known, newly diagnosed, or no AF. METHODS In our multicentre, prospective registry study, we included patients with confirmed ACS. Patients are classified as having known, newly diagnosed or no AF. Newly diagnosed AF is subdivided according to the duration of the episode, time of onset, post-coronary artery bypass graft (CABG) or spontaneous occurrence, and treatment with oral anticoagulants (OAC). The primary endpoint is MACE at 1 year. Key secondary endpoints include ischaemic stroke and bleeding complications. RESULTS Amongst 4,433 patients with confirmed ACS, 3,598 (81.2%) had no AF, 438 (9.9%) had newly diagnosed AF, and 397 (9.0%) had known AF. The rates of OAC treatment at discharge were 53.4% in patients with newly diagnosed AF and 89.2% in patients with known AF. After adjusting for baseline imbalances, only new AF was independently associated with increased rates of MACE, whereas known AF was not (hazard ratio [HR] 1.52, 95% confidence interval [CI]: 1.19-1.90 and HR 0.93, 95% CI: 0.70-1.23). For ACS patients with newly diagnosed AF, episodes lasting >24 hours were associated with a higher risk of MACE compared to episodes <24 hours (HR 1.99, 95% CI: 1.36-2.93). Episodes of new AF occurring post-CABG had more favourable outcomes compared to spontaneously occurring new AF (HR for MACE 0.52, 95% CI: 0.31-0.86). OAC treatment rates were higher in the new AF subcategories with higher rates of MACE and ischaemic stroke. CONCLUSIONS Newly diagnosed AF in ACS patients was associated with higher rates of MACE and ischaemic stroke compared to ACS patients without or with known AF. Among the ACS patients with new AF, an episode lasting >24 hours was associated with worse outcomes than shorter episodes, while post-CABG occurrence of AF showed relatively better outcomes compared to spontaneously occurring AF. Only 53% of new AF patients were discharged on OAC therapy versus 89% with known AF.
Collapse
Affiliation(s)
| | | | - Nino di Maio
- St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Senna Rayhi
- St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joyce Peper
- St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Jurrien M Ten Berg
- St. Antonius Hospital, Nieuwegein, the Netherlands
- CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
3
|
Petersen JK, Butt JH, Yafasova A, Torp-Pedersen C, Sørensen R, Kruuse C, Vinding NE, Gundlund A, Køber L, Fosbøl EL, Østergaard L. Prognosis and antithrombotic practice patterns in patients with recurrent and transient atrial fibrillation following acute coronary syndrome: A nationwide study. Int J Cardiol 2024; 407:132017. [PMID: 38588863 DOI: 10.1016/j.ijcard.2024.132017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/26/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND First-time detected atrial fibrillation (AF) is associated with aggravated prognosis in patients admitted with acute coronary syndrome (ACS). Yet, among patients surviving beyond one year after ACS, it remains unclear how the recurrence of AF within the initial year after ACS affects the risk of stroke. METHODS With Danish nationwide data from 2000 to 2021, we identified all patients with first-time ACS who were alive one year after discharge (index date). Patients were categorized into: i) no AF; ii) first-time detected AF during ACS admission without a recurrent hospital contact with AF (transient AF); and iii) first-time detected AF during ACS admission with a subsequent recurrent hospital contact with AF (recurrent AF). From index date, two-year rates of ischemic stroke were compared using multivariable adjusted Cox regression analysis. Treatment with antithrombotic therapy was assessed as filled prescriptions between 12 and 15 months following ACS discharge. RESULTS We included 139,137 patients surviving one year post ACS discharge: 132,944 (95.6%) without AF, 3920 (2.8%) with transient AF, and 2273 (1.6%) with recurrent AF. Compared to those without AF, the adjusted two-year hazard ratios of ischemic stroke were 1.45 (95% CI, 1.22-1.71) for patients with transient AF and 1.47 (95% CI: 1.17-1.85) for patients with recurrent AF. Prescription rates of oral anticoagulation increased over calendar time, reaching 68.3% and 78.7% for transient and recurrent AF, respectively, from 2019 to 2021. CONCLUSION In patients surviving one year after ACS with first-time detected AF, recurrent and transient AF were associated with a similarly increased long-term rate of ischemic stroke.
Collapse
Affiliation(s)
- Jeppe Kofoed Petersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Jawad Haider Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Herlev Gentofte University Hospital, Herlev, Denmark; University of Copenhagen, Institute of Clinical Medicine, Copenhagen, Denmark
| | - Naja Emborg Vinding
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Gundlund
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
4
|
Wu N, Li J, Xu X, Yuan Z, Yang L, Chen Y, Xia T, Hu Q, Chen Z, Li C, Xiang Y, Zhang Z, Zhong L, Li Y. Prediction Model of New Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome. Int J Clin Pract 2023; 2023:3473603. [PMID: 36874383 PMCID: PMC9981295 DOI: 10.1155/2023/3473603] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is one of the most common complications of acute coronary syndrome (ACS) patients. Possible risk factors related to new-onset AF (NOAF) in ACS patients have been reported in some studies, and several prediction models have been established. However, the predictive power of these models was modest and lacked independent validation. The aim of this study is to define risk factors of NOAF in patients with ACS during hospitalization and to develop a prediction model and nomogram for individual risk prediction. METHODS Retrospective cohort studies were conducted. A total of 1535 eligible ACS patients from one hospital were recruited for model development. External validation was performed using an external cohort of 1635 ACS patients from another hospital. The prediction model was created using multivariable logistic regression and validated in an external cohort. The discrimination, calibration, and clinical utility of the model were evaluated, and a nomogram was constructed. A subgroup analysis was performed for unstable angina (UA) patients. RESULTS During hospitalization, the incidence of NOAF was 8.21% and 6.12% in the training and validation cohorts, respectively. Age, admission heart rate, left atrial diameter, right atrial diameter, heart failure, brain natriuretic peptide (BNP) level, less statin use, and no percutaneous coronary intervention (PCI) were independent predictors of NOAF. The AUC was 0.891 (95% CI: 0.863-0.920) and 0.839 (95% CI: 0.796-0.883) for the training and validation cohort, respectively, and the model passed the calibration test (P > 0.05). The clinical utility evaluation shows that the model has a clinical net benefit within a certain range of the threshold probability. CONCLUSION A model with strong predictive power was constructed for predicting the risk of NOAF in patients with ACS during hospitalization. It might help with the identification of ACS patients at risk and early intervention of NOAF during hospitalization.
Collapse
Affiliation(s)
- Na Wu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Junzheng Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Xiang Xu
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Zhiquan Yuan
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Lili Yang
- Department of Information, Xinqiao Hospital, Army Medical University, Chongqing 400038, China
| | - Yanxiu Chen
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Tingting Xia
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Qin Hu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Zheng Chen
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Chengying Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Ying Xiang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Zhihui Zhang
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Li Zhong
- Cardiovascular Disease Center, Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| |
Collapse
|
5
|
Sciahbasi A, Gargiulo G, Talarico GP, Cesaro A, Zilio F, De Rosa S, Talanas G, Tebaldi M, Andò G, Rigattieri S, Misuraca L, Cortese B, Imperadore F, Lucci V, Guiducci V, Renda G, Zezza L, Versaci F, Giannico MB, Caruso M, Spaccarotella C, Calabrò P, Esposito G, Tarantini G, Musumeci G, Rubboli A. Design of the PERSEO Registry on the management of patients treated with oral anticoagulants and coronary stent. J Cardiovasc Med (Hagerstown) 2022; 23:738-743. [PMID: 36166340 DOI: 10.2459/jcm.0000000000001372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Percutaneous coronary intervention with stent implantation (PCI-S) in patients requiring chronic oral anticoagulant therapy (OAC) is associated with an increased risk of bleeding and ischemic complications. Different randomized studies showed a significant advantage of a double antithrombotic therapy and superiority of direct oral anticoagulant (DOAC) compared with warfarin, but real-world data are limited. Aim is to evaluate the antithrombotic management and clinical outcome of patients with an indication for OAC who undergo PCI-S in a 'real-world' setting. METHODS The multicentre prospective observational PERSEO (PERcutaneouS coronary intErventions in patients treated with Oral anticoagulant therapy) Registry (ClinicalTrials.gov Identifier: NCT03392948) has been designed to enrol patients requiring OAC treated by PCI-S in 25 Italian centres. A target of at least 1080 patients will be followed for 1 year and data on thromboembolic and bleeding events and changes in antithrombotic therapy will be registered. The primary end point is a combined measure of efficacy and safety outcome (NACE), including major bleeding events and major adverse cardiac and cerebral events at 1-year follow-up in patients treated with DOAC (and dual or triple antiplatelet therapy) compared with the corresponding strategies with vitamin K antagonists. A secondary prespecified analysis has been defined to evaluate NACE in dual versus triple antithrombotic therapy after hospital discharge at 1-year follow-up. CONCLUSION The PERSEO Registry will investigate in a 'real world' setting the safety and efficacy of DOAC versus warfarin and dual versus triple antithrombotic therapy in patients with indication for oral anticoagulant therapy who undergo PCI-S.
Collapse
Affiliation(s)
| | - Giuseppe Gargiulo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II
| | | | - Arturo Cesaro
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano,' Caserta
| | - Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, Trento
| | - Salvatore De Rosa
- Division of Cardiology, Research Center for Cardiovascular Diseases, University Magna Graecia, Catanzaro
| | - Giuseppe Talanas
- Clinical and Interventional Cardiology, Sassari University Hospital
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona
| | - Giuseppe Andò
- Cardiology, Department of Clinical and Experimental Medicine, University of Messina
| | | | | | - Bernardo Cortese
- Department of Cardiology, San Carlo Clinic, Fondazione Ricerca e Innovazione Cardiovascolare Milan
| | | | - Valerio Lucci
- Interventional Cardiology San Filippo and Nicola Hospital, Avezzano
| | | | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara
| | | | | | | | - Marco Caruso
- Division of Interventional Cardiology, ARNAS Civico Hospital, Palermo
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Paolo Calabrò
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano,' Caserta
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua
| | - Giuseppe Musumeci
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin
| | - Andrea Rubboli
- Department of Cardiovascular Diseases-AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy
| |
Collapse
|
6
|
De Luca L, Rubboli A, Lettino M, Tubaro M, Leonardi S, Casella G, Valente S, Rossini R, Sciahbasi A, Natale E, Trambaiolo P, Navazio A, Cipriani M, Corda M, De Nardo A, Francese GM, Napoletano C, Tizzani E, Nardi F, Roncon L, Caldarola P, Riccio C, Gabrielli D, Oliva F, Massimo Gulizia M, Colivicchi F. ANMCO position paper on antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and/or acute coronary syndromes. Eur Heart J Suppl 2022; 24:C254-C271. [PMID: 35663586 PMCID: PMC9155223 DOI: 10.1093/eurheartj/suac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand, antithrombotic therapy should reduce the risk related to recurrent ischaemic events and/or stent thrombosis; on the other hand, care must be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents. In the present ANMCO position paper, we propose a decision-making algorithm on antithrombotic strategies based on scientific evidence and expert consensus to be adopted in the periprocedural phase, at the time of hospital discharge, and in the long-term follow-up of patients with AF undergoing PCI with/without ACS.
Collapse
Affiliation(s)
- Leonardo De Luca
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Andrea Rubboli
- Cardiology, Cardiovascular Department, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Maddalena Lettino
- Department of Cardiology, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Marco Tubaro
- CCU, Intensive and Interventional Cardiology Department, P.O. San Filippo Neri, Roma, Italy
| | - Sergio Leonardi
- University of Pavia and IRCCS S. Matteo Foundation General Hospital, Pavia, Italy
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, Azienda USL di Bologna, Bologna, Italy
| | - Serafina Valente
- Cardio-Thoracic Department, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena, Italy
| | - Roberta Rossini
- Emergency Department and Critical Areas, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | - Enrico Natale
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Paolo Trambaiolo
- Cardiology Department, Ospedale Sandro Pertini, ASL RM2, Roma, Italy
| | - Alessandro Navazio
- Hospital Cardiology Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Manlio Cipriani
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Corda
- Cardiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Alfredo De Nardo
- Cardiology-ICU Department, Ospedale Civile “G. Jazzolino”, Vibo Valentia, Italy
| | - Giuseppina Maura Francese
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Cosimo Napoletano
- Cardiology-ICU Department—Cath Lab, Presidio Ospedaliero “G. Mazzini”, Teramo, Italy
| | | | - Federico Nardi
- Cardiology Department, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
| | - Loris Roncon
- Cardiology Department, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | - Carmine Riccio
- Follow-up of the Post-Acute Patient, Cardio-Vascular Department, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Domenico Gabrielli
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Fabrizio Oliva
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| |
Collapse
|
7
|
Antithrombotic Strategies in Patients with Atrial Fibrillation and Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. J Clin Med 2022; 11:jcm11030512. [PMID: 35159964 PMCID: PMC8836736 DOI: 10.3390/jcm11030512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with atrial fibrillation (AF) are at increased risk for coronary artery disease (CAD). After percutaneous coronary intervention (PCI), the antithrombotic therapy consists of a combination of anticoagulant and antiplatelet agents to reduce the ischemic and thromboembolic risk, at the cost of increased bleeding events. In the past few years, several randomized clinical trials involving over 12,000 patients have been conducted to compare the safety of vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs) in association with a single- or double-antiplatelet agent, in the so-called dual- (DAT) or triple-antithrombotic therapy (TAT). These studies and several meta-analyses showed a consistent benefit for reducing bleeding events of DAT over TAT and of DOAC over VKA, without concerns about ischemic endpoints, except for a trend for increased stent thrombosis risk. The present paper examines current international guidelines’ recommendations and reviews clinical trials, meta-analyses, and observational studies conducted on AF patients treated with DAT or TAT after PCI for acute coronary syndromes.
Collapse
|
8
|
Bor WL, Ten Berg JM. Known or new atrial fibrillation in patients with acute coronary syndrome: what's the difference? Eur Heart J 2021; 42:4562-4564. [PMID: 34586404 DOI: 10.1093/eurheartj/ehab689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
9
|
De Luca L, Rubboli A, Bolognese L, Uguccioni M, Lucci D, Blengino S, Campodonico J, Meynet I, Brach Prever SM, Di Lenarda A, Gabrielli D, Gulizia MM. Is percutaneous coronary intervention safe during uninterrupted direct oral anticoagulant therapy in patients with atrial fibrillation and acute coronary syndromes? Open Heart 2021; 8:openhrt-2021-001677. [PMID: 34261777 PMCID: PMC8281094 DOI: 10.1136/openhrt-2021-001677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/14/2021] [Indexed: 01/29/2023] Open
Abstract
Objectives No data on optimal management of patients with acute coronary syndromes (ACS) on long-term direct oral anticoagulants (DOACs) undergoing percutaneous coronary intervention (PCI) are available. Using the data of the Management of Antithrombotic TherApy in Patients with Chronic or DevelOping AtRial Fibrillation During Hospitalization for PCI study, we sought to compare the outcome of patients with ACS and atrial fibrillation (AF) who underwent PCI during uninterrupted DOAC (UDOAC group) and those who interrupted DOAC before PCI (IDOAC group). Methods The primary outcomes of our analysis were the incidence of major adverse cardiovascular events (MACEs), a composite of death, cerebrovascular events, recurrent myocardial infarction or revascularisation and net adverse clinical events (NACEs), including major bleeding, at 6 months. Results Among the 132 patients on long-term DOAC, 72 (54.6%) underwent PCI during UDOAC and 60 (45.4%) after IDOAC. The mean CHA2DS2-VASc score was 3.8±1.7 and 3.9±1.3 (p=0.89), while the HAS-BLED score was 2.5±1.0 and 2.5±0.9 (p=0.96), in UDOAC and IDOAC groups, respectively. The median time from hospital admission to PCI was 9.5 (IQR: 2.0–31.5) hours in UDOAC and 45.5 (IQR: 22-5–92.0) hours in IDOAC group (p<0.0001). A radial approach was used in 92%, and a drug-eluting stent was implanted in 98% of patients. At 6 months, the rates of MACE (13.9% vs 16.7%) and NACE (20.8% vs 21.7%) did not differ between UDOAC and IDOAC groups. At multivariable analysis, increasing CHA2DS2-VASc score (HR: 1.39; 95% CIs 1.05 to 1.83; p=0.02) resulted as the only independent predictor of NACE. Conclusions Our study shows that PCI is a safe procedure during UDOAC in patients with concomitant ACS and AF.
Collapse
Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Andrea Rubboli
- Department of Cardiology, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | | | - Massimo Uguccioni
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | | | - Simonetta Blengino
- Department of Cardiology, San Luca Institute Italian Institute for Auxology, Milano, Italy
| | | | - Ilaria Meynet
- Department of Cardiology, Ospedale degli Infermi, Rivoli, Italy
| | | | - Andrea Di Lenarda
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Domenico Gabrielli
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Michele Massimo Gulizia
- Deparment of Cardiology, National Centre of Excellence Garibaldi Hospital Garibaldi-Nesima Hospital, Catania, Italy
| | | |
Collapse
|
10
|
Hall TS, Atar D. The Times They Are A-Changin´: Antithrombotic strategies in patients with acute coronary syndrome undergoing coronary stenting who have concomitant atrial fibrillation. Eur J Intern Med 2021; 88:21-22. [PMID: 33934970 DOI: 10.1016/j.ejim.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Trygve S Hall
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|