Medica Cor Hospital, 7000 Ruse, Bulgaria.
Faculty of Public Health and Health Care, Ruse University "Angel Kanchev", 7017 Ruse, Bulgaria.
Medicina (Kaunas). 2024 Aug 10;60(8):1294. doi: 10.3390/medicina60081294.
: Patients with atrial fibrillation and coronary artery disease represent a group with a greater risk of mortality. To evaluate patients with atrial fibrillation (AF) and a significant coronary bifurcation lesion and compare the clinical outcomes between the patients on anticoagulant treatment with Vitamin K antagonist (VKA) and those on direct anticoagulant (DOAC). : This is a prospective study of patients with AF and stable coronary artery disease, who had evidence of a significant coronary bifurcation lesion. A log-rank test was used to assess the difference in mortality between patients taking VKA and those on DOAC. The primary endpoint was the incidence of all-cause and cardiovascular death at mid-term. : A total of 226 patients with AF and a significant bifurcation lesion were included. The mean age was 70.9 ± 9.2, and 70% were males. Of the patients, 123 (54.7%) were on VKA treatment, and 103 (45.3%) were taking DOAC. For a median follow-up time of 55 (39-96) months, overall mortality was 40%, whereas CV mortality was 31%. Both all-cause (28.2% versus 50.4%, = 0.020) and CV death (12.7% versus 24.9%, = 0.032) were significantly lower in patients taking DOAC versus those on VKA. In patients treated with PCI, CV mortality was significantly lower in patients taking DOAC (21.4% versus 40.5%, = 0.032). VKA therapy was an independent predictor of cardiovascular death (HR 1.88; 95% CI 1.11-3.18; = 0.01), together with chronic kidney disease (HR 1.81; 95% CI 1.13-2.92; = 0.01). : Treatment with DOAC in patients with atrial fibrillation and coronary bifurcation lesion was associated with significantly lower mortality independently of the treatment approach. VKA was an independent predictor of CV mortality.
: 患有心房颤动和冠状动脉疾病的患者具有更高的死亡率。评估患有心房颤动（AF）和显著冠状动脉分叉病变的患者，并比较接受维生素 K 拮抗剂（VKA）抗凝治疗的患者和直接抗凝剂（DOAC）的患者的临床结果。 : 这是一项前瞻性研究，纳入了患有 AF 和稳定型冠状动脉疾病且有显著冠状动脉分叉病变证据的患者。使用对数秩检验评估服用 VKA 和 DOAC 的患者之间的死亡率差异。主要终点是中期全因和心血管死亡的发生率。 : 共纳入 226 例患有 AF 和显著分叉病变的患者。平均年龄为 70.9 ± 9.2 岁，70%为男性。其中 123 例（54.7%）接受 VKA 治疗，103 例（45.3%）服用 DOAC。中位随访时间为 55（39-96）个月，总死亡率为 40%，而心血管死亡率为 31%。与服用 VKA 的患者相比，服用 DOAC 的患者全因死亡率（28.2%对 50.4%， = 0.020）和心血管死亡率（12.7%对 24.9%， = 0.032）均显著降低。在接受 PCI 治疗的患者中，服用 DOAC 的患者心血管死亡率显著降低（21.4%对 40.5%， = 0.032）。VKA 治疗是心血管死亡的独立预测因素（HR 1.88；95%CI 1.11-3.18； = 0.01），同时也是慢性肾脏病（HR 1.81；95%CI 1.13-2.92； = 0.01）的独立预测因素。 : 在患有心房颤动和冠状动脉分叉病变的患者中，与治疗方法无关，使用 DOAC 治疗与死亡率显著降低相关。VKA 是心血管死亡率的独立预测因素。
