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

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. Anticoagulant use was poor in atrial fibrillation patients with coronary artery disease (AF‐CAD). Anticoagulant use in elderly patients was protective against the composite outcome. AF‐CAD was independently associated with acute coronary syndrome.