Jensen Thomas, Thrane Pernille Gro, Olesen Kevin Kris Warnakula, Würtz Morten, Nielsen Jens Cosedis, Jensen Lisette Okkels, Madsen Morten, Thim Troels, Dalby Kristensen Steen, Lip Gregory Y H, Maeng Michael
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Eur J Clin Invest. 2022 Apr;52(4):e13717. doi: 10.1111/eci.13717. Epub 2021 Nov 25.
In 2010, the European Society of Cardiology Guidelines on atrial fibrillation (AF) introduced the CHA DS -VASc score to guide initiation of oral anticoagulation. In patients with AF undergoing percutaneous coronary intervention (PCI), triple therapy with oral anticoagulation and dual antiplatelet therapy was recommended to reduce ischaemic risk. We examined how the CHA DS -VASc score impacted oral anticoagulation use and risks of ischaemic and hospitalized bleeding events in patients with AF undergoing PCI.
We included 6,014 patients with AF undergoing first-time PCI in Western Denmark between 2003 and 2017. We divided patients into four groups based on year of PCI and estimated 1-year risks of major adverse cardiac events (MACE) and hospitalization for bleeding.
The proportion of oral anticoagulation users was 48% in 2003-2006 and 49% in 2006-2010. Following the CHA DS -VASc score implementation, the proportion increased to 59% in 2011-2014 and 77% in 2015-2017. Using 2003-2006 as reference, risks of MACE were similar in 2007-2010 (adjusted relative risk [RR ] 0.99, 95% confidence interval [CI] 0.83-1.18) and 2011-2014 (RR 0.92, 95% CI 0.78-1.09), but declined by 23% in 2015-2017 (RR 0.77, 95% CI 0.65-0.92). Hospitalizations for bleeding did not increase despite wider use of triple therapy.
Implementation of the CHA DS -VASc score in the 2010 European guidelines on AF was associated with an increased utilization of oral anticoagulation and triple therapy among AF patients undergoing PCI. These changes were associated with a gradual decline in the risk of MACE, while the risk of hospitalized bleeding remained unchanged.
2010年，欧洲心脏病学会房颤（AF）指南引入CHA₂DS₂-VASc评分以指导口服抗凝治疗的启动。对于接受经皮冠状动脉介入治疗（PCI）的房颤患者，推荐采用口服抗凝药与双联抗血小板治疗的三联疗法以降低缺血风险。我们研究了CHA₂DS₂-VASc评分如何影响接受PCI的房颤患者口服抗凝药的使用以及缺血和住院出血事件的风险。
我们纳入了2003年至2017年在丹麦西部接受首次PCI的6014例房颤患者。根据PCI年份将患者分为四组，并估计主要不良心脏事件（MACE）和出血住院的1年风险。
2003 - 2006年口服抗凝药使用者的比例为48%，2006 - 2010年为49%。在CHA₂DS₂-VASc评分实施后，该比例在2011 - 2014年增至59%，在2015 - 2017年增至77%。以2003 - 2006年为参照，2007 - 2010年MACE风险相似（调整后相对风险[RR]0.99，95%置信区间[CI]0.83 - 1.18），2011 - 2014年也相似（RR 0.92，95%CI 0.78 - 1.09），但在2015 - 2017年下降了23%（RR 0.77，95%CI 0.65 - 0.92）。尽管三联疗法使用更为广泛，但出血住院情况并未增加。
2010年欧洲房颤指南中CHA₂DS₂-VASc评分的实施与接受PCI的房颤患者口服抗凝药及三联疗法使用的增加相关。这些变化与MACE风险的逐渐降低相关，而住院出血风险保持不变。
