title: Coronary artery disease in outpatients with nonvalvular atrial fibrillation: results from the multicenter RAMSES study.
abstract: BACKGROUND
  Nonvalvular atrial fibrillation (NVAF) frequently coexists with coronary artery disease (CAD). However, the optimal antithrombotic strategy for patients with concomitant CAD and NVAF is controversial. The aim of this study is to assess the prevalence of CAD with NVAF and to determine antithrombotic treatment options in patients with or without a history of CAD.
  
  
  METHODS
  ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES study) was a cross-sectional, multicenter, nationwide observational study carried out in NVAF patients. We studied the clinical data of 6264 Turkish patients participating in the RAMSES study. Demographic properties and antithrombotic therapies were recorded and compared between patients with and without CAD.
  
  
  RESULTS
  CAD was present in 1828 (29.2%) of patients with NVAF. Most of the NVAF patients with CAD were men (58%) and comorbid diseases were significantly more common in patients with CAD. Although patients with CAD had higher CHA2DS2VASc scores than those without disease (4.1±1.5 vs. 2.9±1.5; P=0.001), they had lower use of oral anticoagulant (OAC) therapy (66.1 vs. 74.4%, P=0.01). Among OAC drugs, warfarin was the preferred medication in patients with CAD (35.4 vs. 30.6%, P=0.01), whereas nonvitamin K antagonist oral anticoagulants were preferred in patients without CAD (40 vs. 34.3%, P=0.01). Patients with CAD required nearly three-fold higher antiplatelet treatment compared with patients without CAD (57.8 vs. 21.4%, P<0.001).
  
  
  CONCLUSIONS
  CAD affects nearly one-third of patients with NVAF in a real-world setting. Although they merit more aggressive therapy, patients with CAD and NVAF were less likely to receive OAC therapy.
authors.affiliation: aDepartment of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla bDepartment of Cardiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas cDepartment of Cardiology, Kahramanmaraş Necip Fazil State Hospital, Kahramanmaras dDepartment of Cardiology, Fethiye State Hospital, Fethiye eDepartment of Cardiology, Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon fDepartment of Cardiology, Elaziğ Education and Research Hospital, Elazig gDepartment of Cardiology, Burdur State Hospital, Burdur hDepartment of Cardiology, İskilip Atif Hoca State Hospital, Iskilip iDepartment of Cardiology, Samsun Education and Research Hospital, Samsun jKartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Dogan
authors.forename: Özcan
authors.initials: Ö
authors.lastname: Başaran
authors.forename: Osman
authors.initials: O
authors.lastname: Beton
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tekinalp
authors.forename: Ismail
authors.initials: I
authors.lastname: Bolat
authors.forename: Ezgi
authors.initials: E
authors.lastname: Kalaycioğlu
authors.forename: Ahmet Çağri
authors.initials: AÇ
authors.lastname: Aykan
authors.forename: Onur
authors.initials: O
authors.lastname: Taşar
authors.forename: Özgen
authors.initials: Ö
authors.lastname: Şafak
authors.forename: Macit
authors.initials: M
authors.lastname: Kalçik
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yaman
authors.forename: Cevat
authors.initials: C
authors.lastname: Kirma
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors