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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

Kaplan-Meier estimates of all ACS-free survival in AF patients receiving warfarin, aspirin and no therapy.
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pone.0131479.g005: Kaplan-Meier estimates of all ACS-free survival in AF patients receiving warfarin, aspirin and no therapy.

Mentions: Current clinical guidelines recommend antithrombotic therapy in patients with AF when CHA2DS2-VASc ≥1.[11, 36] From this study, common risk factors such as diabetes mellitus and hypertension, components of CHA2DS2-VASc scoring 1 mark, were associated with increased risk of new occurrence CAD. The presence of either of these risk factors will confer an increased risk of ischemic stroke and thus indicate the need for antithrombotic therapy. This study suggested that prescription of antithrombotic therapy in this group of patients will not only lower the subsequent risk of ischemic stroke,[13] but might also lower the risk of new occurrence of CAD, both as stable angina and acute coronary syndromes. (Figs 4 and 5).


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)

Kaplan-Meier estimates of all ACS-free survival in AF patients receiving warfarin, aspirin and no therapy.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0131479.g005: Kaplan-Meier estimates of all ACS-free survival in AF patients receiving warfarin, aspirin and no therapy.
Mentions: Current clinical guidelines recommend antithrombotic therapy in patients with AF when CHA2DS2-VASc ≥1.[11, 36] From this study, common risk factors such as diabetes mellitus and hypertension, components of CHA2DS2-VASc scoring 1 mark, were associated with increased risk of new occurrence CAD. The presence of either of these risk factors will confer an increased risk of ischemic stroke and thus indicate the need for antithrombotic therapy. This study suggested that prescription of antithrombotic therapy in this group of patients will not only lower the subsequent risk of ischemic stroke,[13] but might also lower the risk of new occurrence of CAD, both as stable angina and acute coronary syndromes. (Figs 4 and 5).

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