title: The management of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation: in-hospital-data from the Atrial Fibrillation undergoing Coronary Artery Stenting study.
abstract: Current recommendations on the management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI-S) essentially derive from small, single-center, retrospective datasets. To obtain larger and better quality data, we carried out the prospective, multicenter Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) study. Therefore, consecutive patients with history of or ongoing AF undergoing PCI-S were enrolled, and occurrence of adverse ischemic and bleeding events recorded during 12 months follow-up. In this article, we report the in-hospital observations. Out of the 963 patients, in the majority of cases (49.1%) AF was permanent. The associated risk of stroke, as defined by a CHADS2 -score ≥2, was in 70% of patients moderate to high. Upon enrollment in the registry, 69.3% of patients were on VKA therapy. Overall occurrence of in-hospital major adverse cardiac events was 4.5% (cardiovascular death 1.9%, urgent revascularization in 1.5%, and stroke/arterial thromboembolism in 0.6%). Bleeding complications occurred in 7.1% of patients, being severe in 2.5%. In a logistic regression analysis, no risk factor was independently associated with bleeding events, whereas Clopidogrel treatment decreased and female gender/treatment with gpIIb/IIIa-antagonists, respectively increased the risk for the combined ischemic endpoint. The majority of AF patients undergoing PCI-S are at high stroke risk, and therefore VKA treatment should not be withdrawn and combined anticoagulant and antiplatelet treatment is warranted. Current management appears largely in accordance with current recommendations, whereby accounting for the limited occurrence of in-hospital adverse ischemic and bleeding events.
authors.affiliation: Medical Faculty, Martin Luther-University Halle-Wittenberg, Halle, Germany; Department of Cardiology, Paracelsus Harz-Clinic, Bad Suderode, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Schlitt
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Heli
authors.initials: H
authors.lastname: Lahtela
authors.forename: Josè
authors.initials: J
authors.lastname: Valencia
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Karjalainen
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Mika
authors.initials: M
authors.lastname: Laine
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Saila
authors.initials: S
authors.lastname: Vikman
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: antiplatelets; atrial fibrillation; coronary heart disease; oral anticoagulation