title: Outcome after coronary artery bypass surgery and percutaneous coronary intervention in patients with atrial fibrillation and oral anticoagulation.
abstract: OBJECTIVE
  This study was planned to compare the clinical characteristics and outcome of patients on warfarin treatment for atrial fibrillation (AF) undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
  
  
  METHODS
  This is a retrospective analysis of 121 patients who underwent isolated CABG and 301 patients who underwent PCI.
  
  
  RESULTS
  PCI patients were older (mean age, 72.9 versus 69.8 years) and more often had prior cardiac surgery (15.9% versus 1.7%) and acute coronary syndrome (53.8% versus 21.5%). CABG patients more often had two- and three-vessel disease (95.0% versus 60.2%) and left main stenosis (32.2% versus 7.0%). The 30-day outcome was similar after PCI and CABG. At 3 years, PCI was associated with lower overall survival (72.0% versus 86.4%, P = 0.006), freedom from repeat revascularization (85.3% versus 98.2%, P < 0.001), freedom from myocardial infarction (83.4% versus 93.8%, P = 0.008), and freedom from major cardiovascular events (57.4% versus 78.9%, P < 0.001). Propensity score adjusted analysis showed that PCI was associated with increased risk of all-cause mortality (P = 0.016, RR 2.166, CI 1.155-4.060), myocardial infarction (P = 0.017, RR 3.161, 95% CI 1.227-8.144), repeat revascularization (P = 0.001, RR 13.152, 95% CI 2.799-61.793), and major cardiac and cerebrovascular complications (P = 0.001, RR 2.347, 95% CI 1.408-3.914). There was no difference in terms of stroke and bleeding episodes at any time point.
  
  
  CONCLUSIONS
  In clinical practice, PCI is the preferred revascularization strategy in these frail patients. Patients selected for CABG have a relatively low operative risk and better mid-term outcome in spite of warfarin treatment. The poor prognosis after PCI may mainly reflect frequent co-morbidities in this patient group.
authors.affiliation: Heart Center, Turku University Hospital , Turku , Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Gunn
authors.forename: Kari
authors.initials: K
authors.lastname: Kuttila
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kiviniemi
authors.forename: Antti
authors.initials: A
authors.lastname: Ylitalo
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulation; atrial fibrillation; coronary artery bypass; percutaneous coronary intervention; warfarin