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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
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Prediction-Determining Outcomes and Their Predictors in Atrial Fibrillation Patients Receiving Multicomponent
E N Krivosheeva1, E P Panchenko1, E S Kropacheva1
1National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow.
Kardiologiia
|November 6, 2020
Summary
This study identified key predictors for cardiovascular and bleeding complications in atrial fibrillation patients undergoing PCI with antithrombotic therapy. Growth-differentiation factor 15 (GDF-15) and PAI-1 levels, along with reduced DOAC dose, predict cardiovascular events, while the PRECISE-DAPT score predicts bleeding.
Area of Science:
- Cardiology
- Pharmacology
- Biochemistry
Background:
- Patients with ischemic heart disease (IHD) and atrial fibrillation (AF) require multicomponent antithrombotic therapy (MAT) for percutaneous coronary intervention (PCI), placing them at high risk for thrombotic and hemorrhagic complications.
- Identifying novel risk factors is crucial for predicting outcomes in this high-risk population.
- Direct oral anticoagulants (DOACs) are commonly used in MAT regimens.
Purpose of the Study:
- To identify clinical, angiographic, and biochemical predictors of cardiovascular complications (CVC) and hemorrhagic complications in patients with IHD and AF receiving MAT for elective PCI.
- To analyze predictors for CVC, coronary events, and bleeding separately.
- To evaluate the prognostic significance of biomarkers such as GDF-15, D-dimer, TAFI, and PAI-1.
Main Methods:
- A cohort of 207 patients with IHD and AF receiving DOAC-based MAT for elective PCI were analyzed.
- Follow-up duration was a median of 12 months.
- Endpoints included a composite of CVCs (cardiovascular death, ischemic stroke, venous thromboembolism, ACS, unscheduled PCI), coronary events (ACS, unscheduled PCI), and BARC type 2-5 bleeding. Biomarkers were measured on admission. Cox regression was used for analysis.
Main Results:
- The incidence of CVCs was 16.4%. Independent predictors of CVC included reduced DOAC dose (OR 2.5), GDF-15 >1191 pg/ml (OR 3.76), and PAI-1 >13.2 U/ml (OR 2.67).
- The incidence of coronary complications was 9.2%. Predictors included SYNTAX score >26.5 (OR 4.5), PCI for chronic coronary occlusion (OR 3.21), and GDF-15 >1191 pg/ml (OR 4.70).
- The incidence of bleeding was 26.1%. The only independent predictor was a total PRECISE-DAPT score >30 (OR 3.22).
Conclusions:
- Reduced DOAC dose, elevated GDF-15, and elevated PAI-1 are independent predictors of CVC in IHD and AF patients undergoing PCI with MAT.
- High SYNTAX score, PCI for chronic coronary occlusion, and elevated GDF-15 predict coronary complications.
- The PRECISE-DAPT score is a significant predictor of bleeding complications in this patient group.
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