title: Impact of atrial fibrillation on clinical outcomes among patients with coronary artery disease undergoing revascularisation with drug-eluting stents.
abstract: OBJECTIVE
  Coronary artery disease (CAD) and atrial fibrillation (AF) are major determinants of morbidity and mortality. A combined treatment with antiplatelet agents and vitamin K antagonists limits the risk of stent thrombosis and stroke while increasing the rate of bleeding. The objective of this study was to investigate the impact of atrial fibrillation (AF) on long-term clinical outcomes in patients with CAD undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
  
  
  RESULTS
  Among 6,308 consecutive patients undergoing PCI with DES between 2002 and 2009, 323 (5.3%) patients were diagnosed with AF. We compared clinical outcomes between patients with and those without AF throughout four years. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), ischaemic stroke, and BARC bleeding type 3b/3c/5a/5b. In adjusted analyses, the primary composite endpoint was more frequent among patients with AF (HR 1.59, 95% CI 1.26-2.00; p<0.001). Differences were driven by an increased risk of all-cause mortality (HR 1.67, 95% CI 1.27-2.20; p=0.003), ischaemic stroke (HR 3.09, 95% CI 1.45-6.56; p=0.003), and intracranial bleeding (HR 4.28, 95% CI 1.36-13.48; p=0.013). We observed a gradient of risk among patients with higher CHA2DS2-VASc scores and modified outpatient bleeding risk index.
  
  
  CONCLUSIONS
  Among patients with CAD undergoing revascularisation with DES, AF confers an increased risk of all-cause mortality, ischaemic stroke, and intracranial bleeding. The hazard imposed by AF correlates with the CHA2DS2-VASc score.
authors: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors: Thomas
authors: T
authors: Pilgrim
authors: Bindu
authors: B
authors: Kalesan
authors: Thomas
authors: T
authors: Zanchin
authors: Cédric
authors: C
authors: Pulver
authors: Simon
authors: S
authors: Jung
authors: Heinrich
authors: H
authors: Mattle
authors: Thierry
authors: T
authors: Carrel
authors: Aris
authors: A
authors: Moschovitis
authors: Stefan
authors: S
authors: Stortecky
authors: Peter
authors: P
authors: Wenaweser
authors: Giulio G
authors: GG
authors: Stefanini
authors: Lorenz
authors: L
authors: Räber
authors: Bernhard
authors: B
authors: Meier
authors: Peter
authors: P
authors: Jüni
authors: Stephan
authors: S
authors: Windecker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome