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Published on: February 26, 2013
Current status of percutaneous coronary intervention in patients with atrial fibrillation: The Fushimi AF Registry
Mitsuru Abe1, Nobutoyo Masunaga1, Mitsuru Ishii1
1Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Insights
Approximately 1% of atrial fibrillation patients undergo percutaneous coronary intervention annually. Higher CHADS2 scores, particularly due to diabetes, are linked to increased PCI incidence in these patients.
Area of Science:
- Cardiology
- Internal Medicine
- Epidemiology
Background:
- Optimal antithrombotic therapy for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) remains uncertain.
- Choosing antithrombotic therapy post-PCI for AF patients on oral anticoagulants is challenging, especially with high CHADS2 scores.
- Data on PCI incidence in AF patients are limited.
Purpose of the Study:
- To evaluate the incidence of PCI procedures in AF patients.
- To assess the association between PCI and the CHADS2 score in AF patients.
- To identify specific risk factors within the CHADS2 score associated with PCI.
Main Methods:
- Utilized data from the Fushimi AF Registry, a community-based prospective cohort study.
- Followed 4325 AF patients with a median follow-up of 3.6 years.
- Analyzed the incidence of PCI procedures and their correlation with CHADS2 scores and individual risk factors.
Main Results:
- 143 PCI procedures were performed in 122 patients (crude incidence 9.36 per 1000 person-years).
- Cumulative PCI incidence was 1.1% at 1 year and 2.4% at 3 years.
- Patients with CHADS2 score ≥2 had a higher incidence of PCI compared to those with a score ≤1. Diabetes mellitus was significantly associated with PCI (HR, 1.95).
Conclusions:
- About 1% of AF patients undergo PCI annually.
- Higher CHADS2 scores are associated with increased PCI incidence in AF patients.
- Diabetes mellitus is a significant predictor of PCI procedures in AF patients.
Background:
Antithrombotic therapies that are optimal for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) have been studied but remain uncertain. We often encounter difficulties in choosing an appropriate antithrombotic therapy with antiplatelet agents after PCI in AF patients treated with oral anticoagulant due to a high CHADS2 score. Since there are no data on the incidences of PCI procedures in AF patients, we evaluated those incidences as well as the association between PCI and the CHADS2 score using data from the Fushimi AF Registry.
Methods:
The Fushimi AF Registry is a community-based prospective cohort study of AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available for 4325 patients, and the median follow-up was 3.6 (interquartile range: 1.9-5.9) years.
Results:
There were 143 PCI procedures performed in 122 patients during follow-up, and 28 (20%) were emergent ones. The crude incidence of PCI procedures was 9.36 per 1000 person-years. At 1 and 3 years, the cumulative incidences of PCI were 46 (1.1%) and 85 (2.4%), respectively. As for 4 age groups: <65 (n = 765), 65-75 (n = 1359), 75-85 (n = 1586), and 85≤ years (n = 615), the rates of PCI were 0.4%, 1.4%, 1.4%, and 0.6% at 1 year, and were 1.4%, 2.7%, 2.8%, and 1.6% at 3 years, respectively. The incidence of PCI procedures in patients with a CHADS2 score ≥2 (n = 2651, 61.3%) was higher than that in patients with a CHADS2 score ≤1 (n = 1674, 38.7%). Among the factors making up the CHADS2 score, only diabetes mellitus was associated with PCI procedures in patients with AF (hazard ratio, 1.95; 95% confidence interval, 1.34-2.83; p = 0.0005).
Conclusions:
About 1 in 100 AF patients underwent PCI annually, and patients with a CHADS2 score ≥2 were associated with higher incidences of PCI procedures.
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