The online version of this article (doi:10.1007/s00392-016-1071-0) contains supplementary material, which is available to authorized users.
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).
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.
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).
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.
Supplementary material 1 (DOCX 14 KB)392_2016_1071_MOESM1_ESM.docx
Freedman B, Potpara TS, Lip GYH (2016) Stroke prevention in atrial fibrillation. The Lancet 388:806–817 CrossRef
Lip GYH, Windecker S, Huber K, Kirchhof P, Marin F, Ten Berg JM et al (2014) Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on. Eur Heart J 35:3155–3179 CrossRefPubMed
Schlitt A, Rubboli A, Lip GYH, Lahtela H, Valencia J, Karjalainen PP et al (2013) The management of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation: in-hospital-data from the atrial fibrillation undergoing coronary artery stenting study. Catheter Cardiovasc Interv 82:E864–E870 CrossRefPubMed
Rosendaal FR, Cannegieter SC, van der Meer FJ, Briët E (1993) A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 69:236–239 PubMed
Connolly SJ, Pogue J, Eikelboom J, Flaker G, Commerford P, Franzosi MG et al (2008) Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation 118:2029–2037 CrossRefPubMed
Bolton K et al (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266
Go AS, Fang MC, Udaltsova N, Chang Y, Pomernacki NK, Borowsky L et al (2009) Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation 119:1363–1369 CrossRefPubMedPubMedCentral
Bonde AN, Lip GYHH, Kamper A-L, Hansen PR, Lamberts M, Hommel K et al (2014) Net clinical benefit of antithrombotic therapy in patients with atrial fibrillation and chronic kidney disease. J Am Coll Cardiol 64:2471–2482
Piccini JP, Stevens SR, Chang Y, Singer DE, Lokhnygina Y, Go AS et al (2013) Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts. Circulation 127:224–232 CrossRefPubMed
Chan EW, Lau WCY, Siu CW, Lip GYH, Leung WK, Anand S et al (2016) Effect of suboptimal anticoagulation treatment with antiplatelet therapy and warfarin on clinical outcomes in patients with nonvalvular atrial fibrillation: a population-wide cohort study. Hear Rhythm 13:1581–1588 CrossRef
Maree AO, Margey RJ, Selzer F, Bajrangee A, Jneid H, Marroquin OC et al (2016) Renal insufficiency, bleeding and prescription of discharge medication in patients undergoing percutaneous coronary intervention in the national heart, lung, and blood institute (NHLBI) dynamic registry. Cardiovasc Revasc Med 17:302–327 CrossRefPubMed
- 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
K. E. Juhani Airaksinen
Pasi P. Karjalainen
Gregory Y. H. Lip
On behalf of the AFCAS Study Group
- Springer Berlin Heidelberg
Neu im Fachgebiet Kardiologie
Mail Icon II