Dogan Volkan, Başaran Özcan, Beton Osman, Tekinalp Mehmet, Bolat Ismail, Kalaycioğlu Ezgi, Aykan Ahmet Çağri, Taşar Onur, Şafak Özgen, Kalçik Macit, Yaman Mehmet, Kirma Cevat, Biteker Murat
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.
Coron Artery Dis. 2016 Sep;27(6):497-503. doi: 10.1097/MCA.0000000000000389.
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.
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.
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).
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.
非瓣膜性心房颤动（NVAF）常与冠状动脉疾病（CAD）并存。然而，CAD合并NVAF患者的最佳抗栓策略存在争议。本研究旨在评估CAD合并NVAF的患病率，并确定有或无CAD病史患者的抗栓治疗方案。
土耳其评估卒中预防策略的真实生活多中心调查（RAMSES研究）是一项在NVAF患者中开展的横断面、多中心、全国性观察性研究。我们研究了参与RAMSES研究的6264例土耳其患者的临床资料。记录并比较有CAD和无CAD患者的人口统计学特征及抗栓治疗情况。
1828例（29.2%）NVAF患者存在CAD。大多数合并CAD的NVAF患者为男性（58%），CAD患者的合并症明显更常见。尽管CAD患者的CHA2DS2VASc评分高于无CAD患者（4.1±1.5对2.9±1.5；P=0.001），但他们口服抗凝剂（OAC）治疗的使用率较低（66.1%对74.4%，P=0.01）。在OAC药物中，华法林是CAD患者的首选药物（35.4%对30.6%，P=0.01），而无CAD患者更倾向于使用非维生素K拮抗剂口服抗凝剂（40%对34.3%，P=0.01）。与无CAD患者相比，CAD患者的抗血小板治疗需求高出近三倍（57.8%对21.4%，P<0.001）。
在现实世界中，CAD影响近三分之一的NVAF患者。尽管CAD合并NVAF患者应接受更积极的治疗，但他们接受OAC治疗的可能性较小。
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