Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry
Combination of oral anticoagulation (OAC) and antiplatelets is used in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention and stent (PCI-S) procedure but is associated with increased bleeding when triple antithrombotic therapy (TAT) is used. Our aim was to analyze the im...
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| Veröffentlicht in: | The American heart journal 2017-08, Vol.190, p.86-93 |
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| creator | Proietti, Marco Airaksinen, K.E. Juhani Rubboli, Andrea Schlitt, Axel Kiviniemi, Tuomas Karjalainen, Pasi P. Lip, Gregory YH |
| description | Combination of oral anticoagulation (OAC) and antiplatelets is used in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention and stent (PCI-S) procedure but is associated with increased bleeding when triple antithrombotic therapy (TAT) is used. Our aim was to analyze the impact of time in therapeutic range (TTR) on outcomes, in patients prescribed with TAT.
Ancillary analysis from the AFCAS registry in patients assigned to TAT. TTR was calculated with Rosendaal method. Outcomes were analyzed according to TTR tertiles (T1 [≤56.8%] vs. T2 [56.9–93.8%] vs. T3 [≥93.9%]). Major bleeding was the primary outcome.
Of 963 patients enrolled, 470(48.8%) were prescribed with TAT at discharge and qualified for this analysis. Median [IQR] TTR was 80.0% [45.3–100%]. After 359 [341–370] days, major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, P=.006).
Kaplan–Meier analysis demonstrated a progressively lower risk for major bleeding across tertiles (P=.006). Patients in the highest TTR tertile had a non-significant lower risk for major adverse coronary and cerebrovascular events (MACCE) (log-rank: 4.905, P=.086).
Cox regression analysis showed that T2 and T3 were inversely associated with major bleeding (hazard ratio [HR]:0.39, P=.050 and HR: 0.21, P=.005). Continuous TTR was inversely associated with major bleeding (HR: 0.98, P |
| doi_str_mv | 10.1016/j.ahj.2017.05.016 |
| format | Article |
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Ancillary analysis from the AFCAS registry in patients assigned to TAT. TTR was calculated with Rosendaal method. Outcomes were analyzed according to TTR tertiles (T1 [≤56.8%] vs. T2 [56.9–93.8%] vs. T3 [≥93.9%]). Major bleeding was the primary outcome.
Of 963 patients enrolled, 470(48.8%) were prescribed with TAT at discharge and qualified for this analysis. Median [IQR] TTR was 80.0% [45.3–100%]. After 359 [341–370] days, major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, P=.006).
Kaplan–Meier analysis demonstrated a progressively lower risk for major bleeding across tertiles (P=.006). Patients in the highest TTR tertile had a non-significant lower risk for major adverse coronary and cerebrovascular events (MACCE) (log-rank: 4.905, P=.086).
Cox regression analysis showed that T2 and T3 were inversely associated with major bleeding (hazard ratio [HR]:0.39, P=.050 and HR: 0.21, P=.005). Continuous TTR was inversely associated with major bleeding (HR: 0.98, P<.001). For MACCE, adjusted Cox analysis found a non-significant lower risk for T3 (HR: 0.64, P=.128).
In AF patients undergoing PCI-S prescribed TAT, good quality anticoagulation control (as reflected by TTR) was closely related to bleeding outcomes during follow-up. Despite some suggestive trends for an inverse relationship between TTR and MACCE, no definitive conclusions can be drawn, and further large studies are needed.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2017.05.016</identifier><identifier>PMID: 28760217</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Angioplasty ; Anticoagulants ; Anticoagulants - therapeutic use ; Atrial Fibrillation - complications ; Bleeding ; Cardiac arrhythmia ; Cardiovascular disease ; Cerebrovascular system ; Clinical outcomes ; Coronary artery ; Coronary Artery Disease - complications ; Coronary Artery Disease - surgery ; Coronary vessels ; Coronary Vessels - surgery ; Endoscopy ; Europe - epidemiology ; Female ; Fibrillation ; Follow-Up Studies ; Humans ; Impact analysis ; Implants ; Incidence ; Intervention ; Ischemia ; Male ; Medical imaging ; Patients ; Percutaneous Coronary Intervention - methods ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Prognosis ; Prospective Studies ; Registries ; Regression analysis ; Risk ; Sensitivity analysis ; Stents ; Stroke ; Surgical implants ; Survival Rate - trends ; Thromboembolism ; Thromboembolism - epidemiology ; Thromboembolism - etiology ; Thromboembolism - prevention & control ; Thrombosis ; Time Factors</subject><ispartof>The American heart journal, 2017-08, Vol.190, p.86-93</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 1, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c490t-743c69d0134e26ef039217239265cc6348f432bbef1431058ee06cdf3d3f0b3a3</citedby><cites>FETCH-LOGICAL-c490t-743c69d0134e26ef039217239265cc6348f432bbef1431058ee06cdf3d3f0b3a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1925898970?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3538,27906,27907,45977,64365,64367,64369,72219</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28760217$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Proietti, Marco</creatorcontrib><creatorcontrib>Airaksinen, K.E. Juhani</creatorcontrib><creatorcontrib>Rubboli, Andrea</creatorcontrib><creatorcontrib>Schlitt, Axel</creatorcontrib><creatorcontrib>Kiviniemi, Tuomas</creatorcontrib><creatorcontrib>Karjalainen, Pasi P.</creatorcontrib><creatorcontrib>Lip, Gregory YH</creatorcontrib><creatorcontrib>on behalf of the AFCAS Study Group</creatorcontrib><creatorcontrib>AFCAS Study Group</creatorcontrib><title>Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Combination of oral anticoagulation (OAC) and antiplatelets is used in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention and stent (PCI-S) procedure but is associated with increased bleeding when triple antithrombotic therapy (TAT) is used. Our aim was to analyze the impact of time in therapeutic range (TTR) on outcomes, in patients prescribed with TAT.
Ancillary analysis from the AFCAS registry in patients assigned to TAT. TTR was calculated with Rosendaal method. Outcomes were analyzed according to TTR tertiles (T1 [≤56.8%] vs. T2 [56.9–93.8%] vs. T3 [≥93.9%]). Major bleeding was the primary outcome.
Of 963 patients enrolled, 470(48.8%) were prescribed with TAT at discharge and qualified for this analysis. Median [IQR] TTR was 80.0% [45.3–100%]. After 359 [341–370] days, major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, P=.006).
Kaplan–Meier analysis demonstrated a progressively lower risk for major bleeding across tertiles (P=.006). Patients in the highest TTR tertile had a non-significant lower risk for major adverse coronary and cerebrovascular events (MACCE) (log-rank: 4.905, P=.086).
Cox regression analysis showed that T2 and T3 were inversely associated with major bleeding (hazard ratio [HR]:0.39, P=.050 and HR: 0.21, P=.005). Continuous TTR was inversely associated with major bleeding (HR: 0.98, P<.001). For MACCE, adjusted Cox analysis found a non-significant lower risk for T3 (HR: 0.64, P=.128).
In AF patients undergoing PCI-S prescribed TAT, good quality anticoagulation control (as reflected by TTR) was closely related to bleeding outcomes during follow-up. Despite some suggestive trends for an inverse relationship between TTR and MACCE, no definitive conclusions can be drawn, and further large studies are needed.</description><subject>Acute coronary syndromes</subject><subject>Angioplasty</subject><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - complications</subject><subject>Bleeding</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Cerebrovascular system</subject><subject>Clinical outcomes</subject><subject>Coronary artery</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary vessels</subject><subject>Coronary Vessels - surgery</subject><subject>Endoscopy</subject><subject>Europe - epidemiology</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Impact analysis</subject><subject>Implants</subject><subject>Incidence</subject><subject>Intervention</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Regression analysis</subject><subject>Risk</subject><subject>Sensitivity analysis</subject><subject>Stents</subject><subject>Stroke</subject><subject>Surgical implants</subject><subject>Survival Rate - trends</subject><subject>Thromboembolism</subject><subject>Thromboembolism - epidemiology</subject><subject>Thromboembolism - etiology</subject><subject>Thromboembolism - prevention & control</subject><subject>Thrombosis</subject><subject>Time Factors</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc1u1DAUhSMEokPhAdggS2zaRYJ_8ktX0agDSJVYdLq2HOdmxtEkDtfOSPOWPBJOpwXEgo0tX3_n6N57oug9owmjLP_UJ2rfJ5yyIqFZEiovohWjVRHnRZq-jFaUUh6XBRUX0Rvn-vDMeZm_ji54WeSUs2IV_dyaAYgZid8DqglmbzRBNe6AqLElg-otEtUeAR0QO3ttB3ALrzwadSCdadAcDsobO5IpXDB6R-axBdxZM-7IBKhnr0awsyPaoh0VnoKBBzwGNsg-k-0eSH322_zt9_DHZv2srDEoT-TeL-LwcVVv1vX9NUHYGefx9DZ61amDg3dP92X0sLndrr_Gd9-_fFvXd7FOK-rjIhU6r1rKRAo8h46KKuyDhzPPtM5FWnap4E0DHUsFo1kJQHPddqIVHW2EEpfR1dl3QvtjBuflYJyG0PrjqJJVPOMFZykN6Md_0N7OOIbuHqmyKqtiodiZ0midQ-jkhGYII0tG5RK37GWIWy5xS5rJUAmaD0_OczNA-1vxnG8Abs4AhFUcDaB0OkSkoTUI2svWmv_Y_wJdKr8e</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Proietti, Marco</creator><creator>Airaksinen, K.E. 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Juhani ; Rubboli, Andrea ; Schlitt, Axel ; Kiviniemi, Tuomas ; Karjalainen, Pasi P. ; Lip, Gregory YH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c490t-743c69d0134e26ef039217239265cc6348f432bbef1431058ee06cdf3d3f0b3a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute coronary syndromes</topic><topic>Angioplasty</topic><topic>Anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>Atrial Fibrillation - complications</topic><topic>Bleeding</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Cerebrovascular system</topic><topic>Clinical outcomes</topic><topic>Coronary artery</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary vessels</topic><topic>Coronary Vessels - surgery</topic><topic>Endoscopy</topic><topic>Europe - epidemiology</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Impact analysis</topic><topic>Implants</topic><topic>Incidence</topic><topic>Intervention</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Regression analysis</topic><topic>Risk</topic><topic>Sensitivity analysis</topic><topic>Stents</topic><topic>Stroke</topic><topic>Surgical implants</topic><topic>Survival Rate - trends</topic><topic>Thromboembolism</topic><topic>Thromboembolism - epidemiology</topic><topic>Thromboembolism - etiology</topic><topic>Thromboembolism - prevention & control</topic><topic>Thrombosis</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Proietti, Marco</creatorcontrib><creatorcontrib>Airaksinen, K.E. Juhani</creatorcontrib><creatorcontrib>Rubboli, Andrea</creatorcontrib><creatorcontrib>Schlitt, Axel</creatorcontrib><creatorcontrib>Kiviniemi, Tuomas</creatorcontrib><creatorcontrib>Karjalainen, Pasi P.</creatorcontrib><creatorcontrib>Lip, Gregory YH</creatorcontrib><creatorcontrib>on behalf of the AFCAS Study Group</creatorcontrib><creatorcontrib>AFCAS Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Proietti, Marco</au><au>Airaksinen, K.E. Juhani</au><au>Rubboli, Andrea</au><au>Schlitt, Axel</au><au>Kiviniemi, Tuomas</au><au>Karjalainen, Pasi P.</au><au>Lip, Gregory YH</au><aucorp>on behalf of the AFCAS Study Group</aucorp><aucorp>AFCAS Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2017-08</date><risdate>2017</risdate><volume>190</volume><spage>86</spage><epage>93</epage><pages>86-93</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>Combination of oral anticoagulation (OAC) and antiplatelets is used in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention and stent (PCI-S) procedure but is associated with increased bleeding when triple antithrombotic therapy (TAT) is used. Our aim was to analyze the impact of time in therapeutic range (TTR) on outcomes, in patients prescribed with TAT.
Ancillary analysis from the AFCAS registry in patients assigned to TAT. TTR was calculated with Rosendaal method. Outcomes were analyzed according to TTR tertiles (T1 [≤56.8%] vs. T2 [56.9–93.8%] vs. T3 [≥93.9%]). Major bleeding was the primary outcome.
Of 963 patients enrolled, 470(48.8%) were prescribed with TAT at discharge and qualified for this analysis. Median [IQR] TTR was 80.0% [45.3–100%]. After 359 [341–370] days, major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, P=.006).
Kaplan–Meier analysis demonstrated a progressively lower risk for major bleeding across tertiles (P=.006). Patients in the highest TTR tertile had a non-significant lower risk for major adverse coronary and cerebrovascular events (MACCE) (log-rank: 4.905, P=.086).
Cox regression analysis showed that T2 and T3 were inversely associated with major bleeding (hazard ratio [HR]:0.39, P=.050 and HR: 0.21, P=.005). Continuous TTR was inversely associated with major bleeding (HR: 0.98, P<.001). For MACCE, adjusted Cox analysis found a non-significant lower risk for T3 (HR: 0.64, P=.128).
In AF patients undergoing PCI-S prescribed TAT, good quality anticoagulation control (as reflected by TTR) was closely related to bleeding outcomes during follow-up. Despite some suggestive trends for an inverse relationship between TTR and MACCE, no definitive conclusions can be drawn, and further large studies are needed.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28760217</pmid><doi>10.1016/j.ahj.2017.05.016</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Acute coronary syndromes Angioplasty Anticoagulants Anticoagulants - therapeutic use Atrial Fibrillation - complications Bleeding Cardiac arrhythmia Cardiovascular disease Cerebrovascular system Clinical outcomes Coronary artery Coronary Artery Disease - complications Coronary Artery Disease - surgery Coronary vessels Coronary Vessels - surgery Endoscopy Europe - epidemiology Female Fibrillation Follow-Up Studies Humans Impact analysis Implants Incidence Intervention Ischemia Male Medical imaging Patients Percutaneous Coronary Intervention - methods Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Prognosis Prospective Studies Registries Regression analysis Risk Sensitivity analysis Stents Stroke Surgical implants Survival Rate - trends Thromboembolism Thromboembolism - epidemiology Thromboembolism - etiology Thromboembolism - prevention & control Thrombosis Time Factors |
| title | Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry |
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