The Anti-platelet/Anti-coagulation strategy and Prognosis in Coronary Artery Disease Patients Combining With Atrial Fibrillation After Percutaneous Coronary Intervention
10.3969/j.issn.1000-3614.2015.08.002
- VernacularTitle:冠心病合并心房颤动患者经皮冠状动脉介入治疗术后抗血小板抗凝治疗策略
- Author:
Xun YUAN
;
Wenyao WANG
;
Kuo ZHANG
;
Min YANG
;
Xuan ZHANG
;
Jing CHEN
;
Kefei DOU
;
Hongbing YAN
;
Yongjian WU
;
Shubin QIAO
;
Yuejin YANG
;
Yida TANG
- Publication Type:Journal Article
- Keywords:
Coronary artery disease;
Atrial ifbrillation;
Percutaneous coronary intervention;
Anti-platelet/Anti-coagulation therapy;
Thrombus-embolism;
Risk of bleeding
- From:
Chinese Circulation Journal
2015;(8):723-727
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the correlation between antithrombotic strategy and its prognostic value in coronary artery disease (CAD) patients combining with atrial ifbrillation (AF) after percutaneous coronary intervention (PCI).
Methods: A total of 570 CAD patients with AF received PCI in our hospital from 2012-01 to 2013-12 were retrospectively analyzed by CHADS2 and HAS-BLED Score system. According to CHADS2 < 2 and CHADS2 ≥ 2 or with/without warfarin medication, the patients were divided into 2 groups:①CHADS2 < 2 (Low risk of stroke) group,n=339 including 309 patients without warfarin and 30 with warfarin medication;②CHADS2 ≥ 2 (High risk of stroke) group,n=231 including 200 patients without warfarin and 31 with warfarin medication. All patients were followed-up for 15 months to compare the different anti-platelet/ anti-coagulation strategies for the occurrence rate of MACCE, ischemic and bleeding events.
Results: Compared with Low risk of stroke group, the patients in High risk of stroke group had the worse prognosis and higher rate of MACCE occurrence,P<0.001, HR=2.677, 95% CI (1.535-4.635), more ischemic events,P=0.013, HR=2.080, 95% CI (1.167-3.709). Multi-factor Cox surving analysis indicated that compared with low risk patients without warfarin medication, the high risk patients without warfarin had the higher rate of MACCE occurrence,P=0.001, HR=2.985, 95% CI (1.532-5.816), more ischemic events,P=0.026, HR=2.068, 95% CI (1.090-3.925). Whereas, the occurrence rates of MACCE and ischemic events in high risk, low risk patients with warfarin and low risk patients without warfarin were similar, all P>0.05. The major bleeding events in patients with warfarin were a little higher than those without warfarin,P>0.05. The minor bleeding events were increased in both Low risk stroke group asP<0.001, OR=4.458, 95% CI (1.934-10.277) and High risk stroke group asP=0.002, OR=4.155, 95% CI (1.717-10.055).
Conclusion: Warfarin medication may obviously decrease the occurrence rates of MACCE and ischemic events in high risk of stroke patients, while in low risk patients, warfarin could not further decrease the occurrence of MACCE and ischemic events. Warfarin could increase the risk for minor bleeding in both low risk and high risk of stroke in CAD patients combining with AF after PCI.
