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

Current recommendations on the management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI-S) essentially derive from small, single-center, retrospective datasets. To obtain larger and better quality data, we carried out the prospective, multice...

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Veröffentlicht in:Catheterization and cardiovascular interventions 2013-12, Vol.82 (7), p.E864-E870
Hauptverfasser: Schlitt, Axel, Rubboli, Andrea, Lip, Gregory Y H, Lahtela, Heli, Valencia, Josè, Karjalainen, Pasi P, Weber, Michael, Laine, Mika, Kirchhof, Paulus, Niemelä, Matti, Vikman, Saila, Buerke, Michael, Airaksinen, K E Juhani
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container_end_page E870
container_issue 7
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container_title Catheterization and cardiovascular interventions
container_volume 82
creator Schlitt, Axel
Rubboli, Andrea
Lip, Gregory Y H
Lahtela, Heli
Valencia, Josè
Karjalainen, Pasi P
Weber, Michael
Laine, Mika
Kirchhof, Paulus
Niemelä, Matti
Vikman, Saila
Buerke, Michael
Airaksinen, K E Juhani
description Current recommendations on the management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI-S) essentially derive from small, single-center, retrospective datasets. To obtain larger and better quality data, we carried out the prospective, multicenter Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) study. Therefore, consecutive patients with history of or ongoing AF undergoing PCI-S were enrolled, and occurrence of adverse ischemic and bleeding events recorded during 12 months follow-up. In this article, we report the in-hospital observations. Out of the 963 patients, in the majority of cases (49.1%) AF was permanent. The associated risk of stroke, as defined by a CHADS2 -score ≥2, was in 70% of patients moderate to high. Upon enrollment in the registry, 69.3% of patients were on VKA therapy. Overall occurrence of in-hospital major adverse cardiac events was 4.5% (cardiovascular death 1.9%, urgent revascularization in 1.5%, and stroke/arterial thromboembolism in 0.6%). Bleeding complications occurred in 7.1% of patients, being severe in 2.5%. In a logistic regression analysis, no risk factor was independently associated with bleeding events, whereas Clopidogrel treatment decreased and female gender/treatment with gpIIb/IIIa-antagonists, respectively increased the risk for the combined ischemic endpoint. The majority of AF patients undergoing PCI-S are at high stroke risk, and therefore VKA treatment should not be withdrawn and combined anticoagulant and antiplatelet treatment is warranted. Current management appears largely in accordance with current recommendations, whereby accounting for the limited occurrence of in-hospital adverse ischemic and bleeding events.
doi_str_mv 10.1002/ccd.25064
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In a logistic regression analysis, no risk factor was independently associated with bleeding events, whereas Clopidogrel treatment decreased and female gender/treatment with gpIIb/IIIa-antagonists, respectively increased the risk for the combined ischemic endpoint. The majority of AF patients undergoing PCI-S are at high stroke risk, and therefore VKA treatment should not be withdrawn and combined anticoagulant and antiplatelet treatment is warranted. 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To obtain larger and better quality data, we carried out the prospective, multicenter Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) study. Therefore, consecutive patients with history of or ongoing AF undergoing PCI-S were enrolled, and occurrence of adverse ischemic and bleeding events recorded during 12 months follow-up. In this article, we report the in-hospital observations. Out of the 963 patients, in the majority of cases (49.1%) AF was permanent. The associated risk of stroke, as defined by a CHADS2 -score ≥2, was in 70% of patients moderate to high. Upon enrollment in the registry, 69.3% of patients were on VKA therapy. Overall occurrence of in-hospital major adverse cardiac events was 4.5% (cardiovascular death 1.9%, urgent revascularization in 1.5%, and stroke/arterial thromboembolism in 0.6%). Bleeding complications occurred in 7.1% of patients, being severe in 2.5%. In a logistic regression analysis, no risk factor was independently associated with bleeding events, whereas Clopidogrel treatment decreased and female gender/treatment with gpIIb/IIIa-antagonists, respectively increased the risk for the combined ischemic endpoint. The majority of AF patients undergoing PCI-S are at high stroke risk, and therefore VKA treatment should not be withdrawn and combined anticoagulant and antiplatelet treatment is warranted. Current management appears largely in accordance with current recommendations, whereby accounting for the limited occurrence of in-hospital adverse ischemic and bleeding events.</abstract><cop>United States</cop><pmid>23765437</pmid><doi>10.1002/ccd.25064</doi></addata></record>
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source MEDLINE; Wiley Online Library Journals Frontfile Complete
subjects Aged
Aged, 80 and over
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - drug therapy
Atrial Fibrillation - mortality
Chi-Square Distribution
Coronary Artery Disease - complications
Coronary Artery Disease - diagnosis
Coronary Artery Disease - mortality
Coronary Artery Disease - therapy
Europe
Female
Guideline Adherence
Hemorrhage - chemically induced
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - instrumentation
Percutaneous Coronary Intervention - mortality
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
Prospective Studies
Registries
Risk Factors
Sex Factors
Stents
Stroke - etiology
Stroke - prevention & control
Thromboembolism - etiology
Thromboembolism - prevention & control
Time Factors
Treatment Outcome
title 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
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