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



Proietti, Marco ORCID: 0000-0003-1452-2478, Airaksinen, KE Juhani, Rubboli, Andrea, Schlitt, Axel, Kiviniemi, Tuomas, Karjalainen, Pasi P and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2017) 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. CLINICAL RESEARCH IN CARDIOLOGY, 106 (6). pp. 420-427.

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Abstract

<h4>Background</h4>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).<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.

Item Type: Article
Uncontrolled Keywords: Atrial fibrillation, Percutaneous coronary intervention, Quality of anticoagulation control, Renal impairment, Outcomes
Depositing User: Symplectic Admin
Date Deposited: 17 May 2019 10:18
Last Modified: 19 Jan 2023 00:45
DOI: 10.1007/s00392-016-1071-0
Open Access URL: https://doi.org/10.1007/s00392-016-1071-0
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3041754