Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2019 Jan 15;14(1):e0209593. doi: 10.1371/journal.pone.0209593. eCollection 2019.
We investigated the recent 10-year trends in the number of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) in relation to prescription patterns of antithrombotic therapy.
We analyzed the annual prevalence of PCI and patterns of antithrombotic therapy after PCI, including antiplatelets and oral anticoagulants (vitamin K antagonists and non-vitamin K antagonist oral anticoagulants [NOACs]), in patients with AF between 2006 and 2015 by using the Korean National Health Insurance Service database. Independent factors associated with triple therapy (oral anticoagulant plus dual antiplatelet) prescription were assessed using multivariable logistic regression analysis.
The number of patients with AF undergoing PCI increased gradually from 2006 (n = 2,140) to 2015 (n = 3,631) (ptrend<0.001). In 2006, only 22.7% of patients received triple therapy after PCI although 96.2% of them were indicated for anticoagulation (CHA2DS2-VASc score ≥2). The prescription rate of triple therapy increased to 38.3% in 2015 (ptrend<0.001), which was mainly attributed to a recent increment of NOAC-based triple therapy from 2013 (17.5% in 2015). Previous ischemic stroke or systemic embolism, old age, hypertension, and congestive heart failure were significantly associated with a higher triple therapy prescription rate, whereas previous myocardial infarction, PCI, and peripheral arterial disease were associated with triple therapy underuse.
From 2006 to 2015, the number of patients with AF undergoing PCI and the prescription rate of triple therapy increased gradually with a recent increment of NOAC-based antithrombotic therapy from 2013. Previous myocardial infarction, peripheral artery disease, and PCI were associated with underuse of triple therapy.
我们研究了近 10 年来行经皮冠状动脉介入治疗（PCI）的心房颤动（AF）患者数量的变化趋势，以及抗栓治疗方案的变化。
我们利用韩国国家健康保险服务数据库，分析了 2006 年至 2015 年 AF 患者行 PCI 及 PCI 后抗栓治疗（包括抗血小板药物和口服抗凝剂[维生素 K 拮抗剂和非维生素 K 拮抗剂口服抗凝剂（NOAC）]）的年度发生率。采用多变量逻辑回归分析评估与三联治疗（口服抗凝剂加双联抗血小板）处方相关的独立因素。
行 PCI 的 AF 患者数量从 2006 年（n = 2140）逐渐增加到 2015 年（n = 3631）（ptrend<0.001）。2006 年，尽管 96.2%的患者需要抗凝（CHA2DS2-VASc 评分≥2），但仅有 22.7%的患者在 PCI 后接受三联治疗。2015 年三联治疗的处方率增加至 38.3%（ptrend<0.001），这主要归因于 2013 年以来基于 NOAC 的三联治疗的增加（2015 年为 17.5%）。既往缺血性卒中和全身性栓塞、高龄、高血压和充血性心力衰竭与三联治疗高处方率显著相关，而既往心肌梗死、PCI 和外周动脉疾病与三联治疗使用率低相关。
从 2006 年到 2015 年，行 PCI 的 AF 患者数量和三联治疗的处方率逐渐增加，2013 年以来基于 NOAC 的抗栓治疗的比例增加。既往心肌梗死、外周动脉疾病和 PCI 与三联治疗使用率低有关。
