Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
J Cardiol. 2020 May;75(5):513-520. doi: 10.1016/j.jjcc.2019.09.014. Epub 2019 Nov 3.
Antithrombotic therapies that are optimal for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) have been studied but remain uncertain. We often encounter difficulties in choosing an appropriate antithrombotic therapy with antiplatelet agents after PCI in AF patients treated with oral anticoagulant due to a high CHADS score. Since there are no data on the incidences of PCI procedures in AF patients, we evaluated those incidences as well as the association between PCI and the CHADS score using data from the Fushimi AF Registry.
The Fushimi AF Registry is a community-based prospective cohort study of AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available for 4325 patients, and the median follow-up was 3.6 (interquartile range: 1.9-5.9) years.
There were 143 PCI procedures performed in 122 patients during follow-up, and 28 (20%) were emergent ones. The crude incidence of PCI procedures was 9.36 per 1000 person-years. At 1 and 3 years, the cumulative incidences of PCI were 46 (1.1%) and 85 (2.4%), respectively. As for 4 age groups: <65 (n = 765), 65-75 (n = 1359), 75-85 (n = 1586), and 85≤ years (n = 615), the rates of PCI were 0.4%, 1.4%, 1.4%, and 0.6% at 1 year, and were 1.4%, 2.7%, 2.8%, and 1.6% at 3 years, respectively. The incidence of PCI procedures in patients with a CHADS score ≥2 (n = 2651, 61.3%) was higher than that in patients with a CHADS score ≤1 (n = 1674, 38.7%). Among the factors making up the CHADS score, only diabetes mellitus was associated with PCI procedures in patients with AF (hazard ratio, 1.95; 95% confidence interval, 1.34-2.83; p = 0.0005).
About 1 in 100 AF patients underwent PCI annually, and patients with a CHADS score ≥2 were associated with higher incidences of PCI procedures.
对于接受经皮冠状动脉介入治疗（PCI）的心房颤动（AF）患者，哪种抗血栓治疗方案最佳已经过研究，但仍不确定。由于 CHADS 评分较高，我们在接受口服抗凝剂治疗的 AF 患者 PCI 后常难以选择合适的抗血小板药物。由于没有 AF 患者 PCI 手术发生率的数据，我们使用来自 Fushimi AF 注册研究的数据评估了这些发生率以及 PCI 与 CHADS 评分之间的关联。
Fushimi AF 注册研究是一项针对日本京都府船井区 AF 患者的社区为基础的前瞻性队列研究。4325 例患者可获得随访数据，中位随访时间为 3.6（四分位间距：1.9-5.9）年。
在随访期间，122 名患者中有 143 例接受了 PCI 手术，其中 28 例（20%）为紧急手术。PCI 手术的粗发生率为每 1000 人年 9.36 例。在 1 年和 3 年时，PCI 的累积发生率分别为 46（1.1%）和 85（2.4%）。对于 4 个年龄组：<65 岁（n=765）、65-75 岁（n=1359）、75-85 岁（n=1586）和 85 岁及以上（n=615），1 年时的 PCI 发生率分别为 0.4%、1.4%、1.4%和 0.6%，3 年时的 PCI 发生率分别为 1.4%、2.7%、2.8%和 1.6%。CHADS 评分≥2 分（n=2651，61.3%）的患者 PCI 手术发生率高于 CHADS 评分≤1 分（n=1674，38.7%）的患者。在构成 CHADS 评分的因素中，只有糖尿病与 AF 患者的 PCI 手术相关（风险比，1.95；95%置信区间，1.34-2.83；p=0.0005）。
每年约有 1/100 的 AF 患者接受 PCI 治疗，CHADS 评分≥2 分的患者与更高的 PCI 手术发生率相关。
