Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Am J Cardiol. 2014 Jul 1;114(1):70-8. doi: 10.1016/j.amjcard.2014.03.060. Epub 2014 Apr 24.
The prevalence, intensity, safety, and efficacy of oral anticoagulation (OAC) in addition to dual antiplatelet therapy (DAPT) in "real-world" patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not yet been fully evaluated. In the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2, a total of 1,057 patients with AF (8.3%) were identified among 12,716 patients undergoing first PCI. Cumulative 5-year incidence of stroke was higher in patients with AF than in no-AF patients (12.8% vs 5.8%, p <0.0001). Although most patients with AF had CHADS2 score ≥2 (75.2%), only 506 patients (47.9%) received OAC with warfarin at hospital discharge. Cumulative 5-year incidence of stroke in the OAC group was not different from that in the no-OAC group (13.8% vs 11.8%, p = 0.49). Time in therapeutic range (TTR) was only 52.6% with an international normalized ratio of 1.6 to 2.6, and only 154 of 409 patients (37.7%) with international normalized ratio data had TTR ≥65%. Cumulative 5-year incidence of stroke in patients with TTR ≥65% was markedly lower than that in patients with TTR <65% (6.9% vs 15.1%, p = 0.01). In a 4-month landmark analysis in the OAC group, there was a trend for higher cumulative incidences of stroke and major bleeding in the on-DAPT (n = 286) than in the off-DAPT (n = 173) groups (15.1% vs 6.7%, p = 0.052 and 14.7% vs 8.7%, p = 0.10, respectively). In conclusion, OAC was underused and its intensity was mostly suboptimal in real-world patients with AF undergoing PCI, which lead to inadequate stroke prevention. Long-term DAPT in patients receiving OAC did not reduce stroke incidence.
在接受经皮冠状动脉介入治疗（PCI）的房颤（AF）患者的“真实世界”中，口服抗凝治疗（OAC）加双联抗血小板治疗（DAPT）的流行率、强度、安全性和疗效尚未得到充分评估。在京都注册队列-2 的冠状动脉血运重建证明结果研究中，在接受首次 PCI 的 12716 名患者中，共确定了 1057 名 AF 患者（8.3%）。AF 患者的 5 年累积卒中发生率高于无 AF 患者（12.8%比 5.8%，p<0.0001）。尽管大多数 AF 患者的 CHADS2 评分≥2（75.2%），但只有 506 名（47.9%）患者在出院时接受了 OAC 加华法林治疗。OAC 组的 5 年累积卒中发生率与无 OAC 组无差异（13.8%比 11.8%，p=0.49）。INR 为 1.6 至 2.6 时，TTR 仅为 52.6%，只有 409 名患者中有 154 名（37.7%）的 INR 数据 TTR≥65%。TTR≥65%的患者 5 年累积卒中发生率明显低于 TTR<65%的患者（6.9%比 15.1%，p=0.01）。在 OAC 组的 4 个月时间标志分析中，在继续 DAPT（n=286）的患者中，卒中的累积发生率和大出血的发生率均有升高趋势，而在停用 DAPT（n=173）的患者中则没有这种趋势（15.1%比 6.7%，p=0.052 和 14.7%比 8.7%，p=0.10）。总之，在接受 PCI 的 AF 患者中，OAC 的使用率较低，强度大多不理想，导致卒中预防不足。接受 OAC 的患者长期使用 DAPT 并未降低卒中发生率。
