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Predictive models for adverse clinical outcomes in Chinese patients with atrial fibrillation undergoing percutaneous
Jian-Yong Zheng1, Yi Cao1, Dong-Tao Li1
1Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China.
Insights
Predictors for adverse cardiovascular outcomes in Chinese patients with atrial fibrillation (AF) undergoing coronary stenting were identified. Key factors for death, stroke, and bleeding were determined to improve patient management.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with increased risk of cardiovascular events.
- Coronary stenting is a standard procedure for managing coronary artery disease.
- Patients with both AF and coronary artery disease require careful risk stratification and management.
Purpose of the Study:
- To identify predictors of adverse cardiovascular outcomes in Chinese patients with AF undergoing coronary stenting.
- To develop predictive models for all-cause death, ischemic stroke/systemic thromboembolism (IS/STE), major adverse cardiac/cerebrovascular events (MACCE), and major bleeding.
Main Methods:
- Retrospective study of 2394 consecutive patients with non-valvular AF undergoing coronary stenting in Beijing, China (2010-2015).
- Major outcomes included all-cause death, non-fatal myocardial infarction, repeat revascularization, IS/STE, and major bleeding.
- Multivariate Cox regression analysis was used to identify predictive factors.
Main Results:
- The study included 2394 patients with a median follow-up of 36.2 months.
- High rates of all-cause death (9.6%) and MACCE (17.8%) were observed.
- Predictive models identified factors such as diabetes, prior myocardial infarction, chronic kidney disease (CKD), ST-segment elevation myocardial infarction (STEMI), heart failure, and medication use for death and MACCE. Advanced age, prior stroke, and intracranial hemorrhage predicted IS/STE. Prior bleeding, prior MI, CKD, and oral anticoagulant use predicted major bleeding.
Conclusions:
- Chinese patients with AF undergoing coronary stenting face significant risks of mortality and MACCE.
- Distinct predictive models for different adverse outcomes were established, aiding in risk assessment.
- These models can inform clinical decision-making and personalized treatment strategies for this high-risk population.
Objective:
This study aimed to evaluate predictors for adverse cardiovascular outcomes in patients with atrial fibrillation (AF) undergoing coronary stenting.
Methods:
We retrospectively recruited consecutive patients with previously documented non-valvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. Major adverse cardiac/cerebrovascular events (MACCE) were a composite of all-cause death, non-fatal myocardial infarction, repeat revascularization, and ischaemic stroke/systemic thromboembolism (IS/STE). Major bleeding referred to grade 2 or higher of Bleeding Academic Research Consortium criteria.
Results:
A total of 2394 patients (men: 72.3% vs. women: 27.7%, median age: 67 years) were included. The CHA2DS2-VASc and HAS-BLED were 3.6 ± 1.6 and 1.9 ± 0.7, respectively. The median follow-up duration was 36.2 months. There were 230 (9.6%) deaths, 96 (4.0%) IS/STE, 426 (17.8%) MACCE, and 72 (3.0%) major bleeding. Multivariate Cox regression yielded predictive models for (1) all-cause death: diabetes, prior myocardial infarction, chronic kidney disease (CKD), ST-segment elevation myocardial infarction (STEMI) at presentation, heart failure, no use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins; (2) IS/STE: advanced age, prior history of ischaemic stroke and intracranial haemorrhage; (3) MACCE: prior history of myocardial infarction and ischaemic stroke, CKD, STEMI, heart failure, and no statin use; (4) major bleeding: prior major bleeding, prior myocardial infarction, CKD and use of oral anticoagulants.
Conclusion:
Chinese patients with AF and coronary stenting had high mortality and incidence of MACCE. We compiled separate predictive models for all-cause death, IS/STE, MACCE, and major bleeding.
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