Yasuda Kentaro, Iwata Hiroshi, Miyauchi Katsumi, Nojiri Shuko, Nishizaki Yuji, Chikata Yuichi, Minamino Tohru, Daida Hiroyuki
Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan.
Int J Cardiol Cardiovasc Risk Prev. 2025 Aug 13;27:200486. doi: 10.1016/j.ijcrp.2025.200486. eCollection 2025 Dec.
Patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) (ACS + AF) face elevated risks of thrombotic and bleeding events, especially with comorbid chronic kidney disease (CKD). Limited research has assessed the combined influence of CKD in this high-risk population.
This first subanalysis of STAR-ACS study included 445 Japanese ACS + AF patients, stratified by CKD status (eGFR < vs. ≥ 60 mL/min/1.73 m, CKD (+) vs. (-) groups, respectively). Antithrombotic therapy was assessed at baseline, one year, and two years. Primary outcomes included major bleeding and major adverse cardiovascular events.
CKD prevalence was high at 56.4 %. While ratio of dual antiplatelet therapy had drastically decreased by two years, there was no significant difference between CKD (+) and (-) groups. In contrast, among anticoagulants, warfarin was preferably used in CKD (+) group, compared to CKD (-) group, remaining stable for 2 years. Direct oral anticoagulants (DOACs) were prescribed less frequently in CKD patients, with rivaroxaban usage notably lower in CKD (+), while apixaban usage numerically increased in CKD patients. Moreover, CKD was associated with a higher cumulative incidence of adverse outcomes, although this was not statistically significant. However, in DOACs-treated patients, CKD was significantly linked to poorer outcomes, with higher eGFR levels correlating with reduced risk.
This real-world data of ACS + AF patients indicated the significant influence of CKD on anticoagulant choice and on the worse outcome trends. These findings highlight the need for tailored antithrombotic strategies in patients with ACS, AF, and CKD to mitigate bleeding and thrombotic risks.
急性冠状动脉综合征（ACS）合并心房颤动（AF）（ACS+AF）的患者面临血栓形成和出血事件的风险升高，尤其是合并慢性肾脏病（CKD）时。有限的研究评估了CKD在这一高危人群中的综合影响。
STAR-ACS研究的首次亚组分析纳入了445例日本ACS+AF患者，根据CKD状态分层（估算肾小球滤过率[eGFR]<60与≥60 mL/min/1.73 m²，分别为CKD（+）组和（-）组）。在基线、1年和2年时评估抗栓治疗情况。主要结局包括大出血和主要不良心血管事件。
CKD患病率高达56.4%。虽然双联抗血小板治疗的比例在2年内大幅下降，但CKD（+）组和（-）组之间无显著差异。相比之下，在抗凝药物中，与CKD（-）组相比，CKD（+）组更倾向于使用华法林，且2年保持稳定。CKD患者中直接口服抗凝剂（DOACs）的处方频率较低，CKD（+）组中利伐沙班的使用明显较低，而阿哌沙班在CKD患者中的使用量在数值上有所增加。此外，CKD与不良结局的累积发生率较高相关，尽管这在统计学上无显著意义。然而，在接受DOACs治疗的患者中，CKD与较差的结局显著相关，eGFR水平越高，风险越低。
这项ACS+AF患者的真实世界数据表明，CKD对抗凝剂选择和不良结局趋势有显著影响。这些发现凸显了对ACS、AF和CKD患者制定个性化抗栓策略以降低出血和血栓形成风险的必要性。
