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Impact of Antithrombotic Therapy in Atrial Fibrillation on the Presentation of Coronary Artery Disease.

Chan PH, Li WH, Hai JJ, Tse HF, Siu CW - PLoS ONE (2015)

Bottom Line: No significant differences in age, sex, and mean CHA2DS2-VASc score were observed between patients with and without the primary endpoint.Similar trends were observed in patients with acute coronary syndromes.Diabetes mellitus, smoking history and renal failure requiring dialysis were predictors for primary endpoint in all antithrombotic therapies.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background: Little is known about whether atrial fibrillation is a presentation of coronary disease. There is a paucity of knowledge about their causal relationship and also the impact of different antithrombotic strategies on the subsequent presentation of symptomatic coronary disease.

Methods and results: We studied 7,526 Chinese patients diagnosed with non-valvular atrial fibrillation and no documented history of coronary artery disease. The primary endpoint was the new occurrence of coronary artery disease--either stable coronary artery disease or acute coronary syndrome. After a mean follow-up of 3.2±3.5 years (24,071 patient-years), a primary endpoint occurred in 987 patients (13.1%). The overall annual incidence of coronary artery disease was 4.10%/year. No significant differences in age, sex, and mean CHA2DS2-VASc score were observed between patients with and without the primary endpoint. When stratified according to the antithrombotic strategies applied for stroke prevention, the annual incidence of coronary artery disease was 5.49%/year, 4.45%/year and 2.16%/year respectively in those prescribed no antithrombotic therapy, aspirin, and warfarin. Similar trends were observed in patients with acute coronary syndromes. Diabetes mellitus, smoking history and renal failure requiring dialysis were predictors for primary endpoint in all antithrombotic therapies.

Conclusion: In patients with non-valvular atrial fibrillation, there is a modest association with coronary artery disease. Patients prescribed warfarin had the lowest risk of new onset coronary artery disease.

No MeSH data available.


Related in: MedlinePlus

Proportion of patients presenting with stable CAD and ACS (both NSTEMI and STEMI) amongst new occurrence of CAD.
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pone.0131479.g002: Proportion of patients presenting with stable CAD and ACS (both NSTEMI and STEMI) amongst new occurrence of CAD.

Mentions: Amongst those with new occurrence of CAD, 759 patients (76.9%) presented with stable CAD and the remaining 228 patients (23.1%) presented with acute coronary syndrome with either non-ST elevation myocardial infarction (16.5%) or ST-elevation myocardial infarction (6.6%)(Fig 2). The annual incidence of stable CAD was 3.15%/year whereas the annual incidence of acute coronary syndrome was 0.95%/year (non-ST elevation myocardial infarction: 0.7%/year and ST-elevation myocardial infarction: 0.27%/year). When stratified according to antithrombotic therapy, the annual incidence of CAD was 5.49%/year, 4.45%/year and 2.16%/year in those prescribed no antithrombotic therapy, aspirin therapy, and warfarin therapy respectively. Similar trends were likewise observed in acute coronary syndromes (1.3%/year in patients with no antithrombotic therapy, 1.0%/year for aspirin therapy, and 0.5%/year for warfarin therapy)(Fig 3).


Impact of Antithrombotic Therapy in Atrial Fibrillation on the Presentation of Coronary Artery Disease.

Chan PH, Li WH, Hai JJ, Tse HF, Siu CW - PLoS ONE (2015)

Proportion of patients presenting with stable CAD and ACS (both NSTEMI and STEMI) amongst new occurrence of CAD.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476741&req=5

pone.0131479.g002: Proportion of patients presenting with stable CAD and ACS (both NSTEMI and STEMI) amongst new occurrence of CAD.
Mentions: Amongst those with new occurrence of CAD, 759 patients (76.9%) presented with stable CAD and the remaining 228 patients (23.1%) presented with acute coronary syndrome with either non-ST elevation myocardial infarction (16.5%) or ST-elevation myocardial infarction (6.6%)(Fig 2). The annual incidence of stable CAD was 3.15%/year whereas the annual incidence of acute coronary syndrome was 0.95%/year (non-ST elevation myocardial infarction: 0.7%/year and ST-elevation myocardial infarction: 0.27%/year). When stratified according to antithrombotic therapy, the annual incidence of CAD was 5.49%/year, 4.45%/year and 2.16%/year in those prescribed no antithrombotic therapy, aspirin therapy, and warfarin therapy respectively. Similar trends were likewise observed in acute coronary syndromes (1.3%/year in patients with no antithrombotic therapy, 1.0%/year for aspirin therapy, and 0.5%/year for warfarin therapy)(Fig 3).

Bottom Line: No significant differences in age, sex, and mean CHA2DS2-VASc score were observed between patients with and without the primary endpoint.Similar trends were observed in patients with acute coronary syndromes.Diabetes mellitus, smoking history and renal failure requiring dialysis were predictors for primary endpoint in all antithrombotic therapies.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background: Little is known about whether atrial fibrillation is a presentation of coronary disease. There is a paucity of knowledge about their causal relationship and also the impact of different antithrombotic strategies on the subsequent presentation of symptomatic coronary disease.

Methods and results: We studied 7,526 Chinese patients diagnosed with non-valvular atrial fibrillation and no documented history of coronary artery disease. The primary endpoint was the new occurrence of coronary artery disease--either stable coronary artery disease or acute coronary syndrome. After a mean follow-up of 3.2±3.5 years (24,071 patient-years), a primary endpoint occurred in 987 patients (13.1%). The overall annual incidence of coronary artery disease was 4.10%/year. No significant differences in age, sex, and mean CHA2DS2-VASc score were observed between patients with and without the primary endpoint. When stratified according to the antithrombotic strategies applied for stroke prevention, the annual incidence of coronary artery disease was 5.49%/year, 4.45%/year and 2.16%/year respectively in those prescribed no antithrombotic therapy, aspirin, and warfarin. Similar trends were observed in patients with acute coronary syndromes. Diabetes mellitus, smoking history and renal failure requiring dialysis were predictors for primary endpoint in all antithrombotic therapies.

Conclusion: In patients with non-valvular atrial fibrillation, there is a modest association with coronary artery disease. Patients prescribed warfarin had the lowest risk of new onset coronary artery disease.

No MeSH data available.


Related in: MedlinePlus