Huang Bi, Liu Yang, Lam Ho Man, Ishiguchi Hironori, Chao Tze-Fan, Huisman Menno V, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Eur J Clin Invest. 2025 Mar;55(3):e14378. doi: 10.1111/eci.14378. Epub 2025 Jan 13.
Coronary artery disease (CAD) and atrial fibrillation (AF) often coexist, but the impact of clinical phenotypes of CAD on outcomes in AF patients in the non-vitamin K antagonist oral anticoagulant drugs (NOACs) era is less well understood.
This was a post-hoc of the GLORIA-AF registry, a global, multicenter, prospective AF registry study. Patients were divided into three groups: prior history of myocardial infarction (MI)/unstable angina group (Group 1); stable angina group (Group 2); and a control group without stable angina or history of MI/unstable angina. The primary endpoint was the composite of all-cause death or stroke, and the safety endpoint was major bleeding.
A total of 24,827 patients were included in this analysis (median age was 71 (IQR, 64-78) years; 55% male) and 5394 (21.7%) had CAD. During a follow-up of 2 years, the incidence of the primary endpoint was 5.99 (95% CI, 5.33, 6.71) per 100 patient-years in Group 1, 4.04 (95% CI, 3.55, 4.70) per 100 patient-years in Group 2, and 2.79 (95% CI, 2.62, 2.96) per 100 patient-years in the control group (p < .001). Compared the control group, the adjusted hazard ratio of the primary composite endpoint in Groups 1 and 2 were 1.58 (95% CI, 1.37, 1.83, p < .001) and 1.22 (95% CI, 1.04, 1.43, p = .012), respectively. Among anticoagulated patients with AF and CAD, NOACs were associated with a reduced risk of the primary composite endpoint and major bleeding, compared with vitamin K antagonists (VKA).
CAD was prevalent in patients with AF, and clinical phenotypes of CAD influenced outcomes in patients with AF, with a history of MI/unstable angina being associated with a significantly increased risk of CV events, compared to stable angina. NOACs were superior to VKA in terms of the effectiveness and safety outcomes in patients with AF and concomitant CAD.
冠状动脉疾病（CAD）和心房颤动（AF）常并存，但在非维生素K拮抗剂口服抗凝药（NOACs）时代，CAD临床表型对AF患者预后的影响尚不清楚。
这是GLORIA-AF注册研究的事后分析，该研究是一项全球性、多中心、前瞻性AF注册研究。患者分为三组：有心肌梗死（MI）/不稳定型心绞痛病史组（第1组）；稳定型心绞痛组（第2组）；以及无稳定型心绞痛或MI/不稳定型心绞痛病史的对照组。主要终点是全因死亡或卒中的复合终点，安全终点是大出血。
本分析共纳入24827例患者（中位年龄71岁（四分位间距，64 - 78岁）；55%为男性），其中5394例（21.7%）患有CAD。在2年的随访期间，第1组主要终点的发生率为每100患者年5.99（95%CI，5.33，6.71），第2组为每100患者年4.04（95%CI，3.55，4.70），对照组为每100患者年2.79（95%CI，2.62，2.96）（p <.001）。与对照组相比，第1组和第2组主要复合终点的调整后风险比分别为1.58（95%CI，1.37，1.83，p <.001）和1.22（95%CI，1.04，1.43，p = 0.012）。在AF合并CAD的抗凝患者中，与维生素K拮抗剂（VKA）相比，NOACs与主要复合终点和大出血风险降低相关。
CAD在AF患者中普遍存在，CAD的临床表型影响AF患者的预后，与稳定型心绞痛相比，有MI/不稳定型心绞痛病史的患者心血管事件风险显著增加。在AF合并CAD的患者中，NOACs在有效性和安全性方面优于VKA。
