1
|
Kotalczyk A, Guo Y, Fawzy AM, Wang Y, Lip GYH. Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (
ChiOTEAF
) registry. J Arrhythm 2022; 38:580-588. [PMID: 35936042 PMCID: PMC9347193 DOI: 10.1002/joa3.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Atrial fibrillation (AF) and coronary artery disease (CAD) are closely related; CAD may precede or complicate the clinical course of AF. Objective To evaluate the impact of CAD on clinical outcomes among elderly Chinese AF patients. Methods The ChiOTEAF registry is a prospective registry conducted in 44 sites from 20 provinces in China between October 2014 and December 2018. Primary outcome was the composite of all‐cause mortality/any thromboembolism (TE)/major bleeding/acute coronary syndrome (ACS). Results The eligible cohort for this analysis included 6403 individuals (mean age 74.8 ± 10.7; 39.2% female); of these, 3058 (47.8%) had a history of CAD. On multivariate analysis, CAD was independently associated with a higher odds ratio for ACS (OR: 1.98; 95% CI: 1.12–3.52) without a significant impact on other adverse outcomes. Independent variables associated with the composite outcome among CAD patients were: (i) the use of OAC (OR: 0.55; 95% CI: 0.42–0.72), age (OR: 1.09; 95% CI: 1.08–1.11), heart failure (OR: 1.95; 95% CI: 1.51–2.50), prior ischemic stroke (OR: 1.29; 95% CI: 1.02–1.64), chronic kidney disease (OR: 1.71; 95% CI: 1.32–2.22), and chronic obstructive pulmonary disease (OR: 1.42; 95% CI: 1.06–1.89). Conclusions AF patients with CAD were at an increased risk of developing ACS but there was no significant difference in the composite outcome, all cause death, cardiovascular death, thromboembolic events or major bleeding compared to the non‐CAD group. OAC use was inversely associated with adverse events, yet their uptake was poor in the AF‐CAD population.
Collapse
Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy Medical University of Silesia, Silesian Centre for Heart Diseases Zabrze Poland
| | - Yutao Guo
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Centre Chinese PLA General Hospital Beijing China
| | - Ameenathul M. Fawzy
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
| | - Yutang Wang
- Department of Cardiology, Second Medical Centre Chinese PLA General Hospital Beijing China
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy Medical University of Silesia, Silesian Centre for Heart Diseases Zabrze Poland
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| |
Collapse
|
2
|
Park J, Jung JH, Choi EK, Lee SW, Kwon S, Lee SR, Kang J, Han KD, Park KW, Oh S, Lip GYH. Longitudinal Patterns in Antithrombotic Therapy in Patients with Atrial Fibrillation after Percutaneous Coronary Intervention in the Non-Vitamin K Oral Anticoagulant Era: A Nationwide Population-Based Study. J Clin Med 2021; 10:jcm10071505. [PMID: 33916604 PMCID: PMC8038511 DOI: 10.3390/jcm10071505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
We investigated whether longitudinal patterns in antithrombotic therapy have changed after the introduction of non-vitamin K oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI). Using a claims database of the Korean AF population who underwent PCI between 2012 and 2016 (n = 18,691), we analyzed prescription records of oral anticoagulants (OACs) and antiplatelets at 3-month intervals over 2 years after PCI. The study population was stratified (pre-NOAC, transition, and NOAC era) using time-periods of NOAC introduction in Korea and an expansion of reimbursement for NOAC in AF as indicators. The overall rates of OAC were low at baseline (24.9%, 26.9%, and 35.2% in pre-NOAC, transition, and NOAC era, respectively), contrary to high rates of dual antiplatelet therapy (DAPT) (73.3%, 71.4%, and 63.6%). However, OAC prescription rates were increased at 1-year (18.5%, 22.5%, and 31.6%), and 2-year follow-up (17.8%, 24.2%, and 31.8%) from pre-NOAC to NOAC era. In NOAC era, 63.5% of baseline OAC prescriptions comprised NOAC, of which 96.4% included triple therapy with DAPT. Over 2 years, we observed increasing rates of double therapy with a single antiplatelet (18.3% and 20.0% at 1- and 2-year follow-up) and OAC monotherapy (2.7% and 8.9% at 1- and 2-year follow-up).
Collapse
Affiliation(s)
- Jiesuck Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (J.P.); (S.K.); (S.-R.L.); (J.K.); (K.-W.P.); (S.O.)
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
| | - Jin-Hyung Jung
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-H.J.); (K.-D.H.)
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (J.P.); (S.K.); (S.-R.L.); (J.K.); (K.-W.P.); (S.O.)
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
- Correspondence: ; Tel.: +82-2-2072-0688; Fax: +82-2-762-9662
| | - Seung-Woo Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea;
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (J.P.); (S.K.); (S.-R.L.); (J.K.); (K.-W.P.); (S.O.)
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (J.P.); (S.K.); (S.-R.L.); (J.K.); (K.-W.P.); (S.O.)
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
| | - Jeehoon Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (J.P.); (S.K.); (S.-R.L.); (J.K.); (K.-W.P.); (S.O.)
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
| | - Kyung-Do Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-H.J.); (K.-D.H.)
| | - Kyung-Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (J.P.); (S.K.); (S.-R.L.); (J.K.); (K.-W.P.); (S.O.)
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (J.P.); (S.K.); (S.-R.L.); (J.K.); (K.-W.P.); (S.O.)
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
| | - Gregory Y. H. Lip
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Chest & Heart Hospital, Liverpool L14 3PE, UK
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| |
Collapse
|