Antithrombotic Strategies And Prognostic Risk Factors Of Patients With Non-valvular Atrial Fibrillation And Acute Coronary Syndrone Undergoing Percutaneous Coronary Intervention

Background:Atrial fibrillation(AF)is a common supraventricular arrhythmia.The incidence and morbidity of atrial fibrillation are both high,and early diagnosis is especially important to prevent stroke.Many patients need clinical antithrombotic therapy including anticoagulation and antiplatelet,which is common in patients NVAF with acute coronary syndrome undergoing percutaneous coronary intervention(NVAF-PCI).To address these gaps in knowledge of AF patients,the present study was designed with two parts.Part I:Antithrombotic strategies and prognostic risk factors of patients with Non-valvular atrial fibrillation and acute coronary syndrome undergoing Percutaneous Coronary InterventionObjective:To describe the baseline characterristics,demographic information and different strategies at enrillment and outcomes at follow-up,and analyze the risk factors related to prognosis.Methods:The study is a multicenter,retrospective research of patients with Non-valvular atrial fibrillation(NVAF)and acute coronary syndrome(ACS)undergoing Percutaneous Coronary Intervention(PCI)collected in 12 hospitals in Beijing who January 2010 to December 2014.Baseline characteristics and treatment at enrollment were collected.Their Major Adverse cardiovascular and cerebrovascular Events(MACCEs)and major bleeding event were recorded.And compared the different strategies at enrillment and analyze the risk factors related to prognosis.Results:2283 patients with NVAF and ACS undergoing PCI were enrolled.The average follow-up were 40.5±15.1 months.A multivariate logistic regression analysis of the MACCE patients showed that diabetes mellitus,heart failuer,higher NT-proBNP,lower systolic blood pressure tended to be negatively associated with the incidence of MACCE complications(respectively,P=0.017,P=0.019,P=0.018,P=0.012),receiving beta-blockers was positively associated with the incidence of MACCEs complications(P=0.023).Compared with DAPT group,warfarin group was lower(P<0.05)in stroke events,but there was no difference in adverse cardiovascular events and major bleeding events(P>0.05).Left atrial enlargement and homocysteine levels are new independent risk factors for stroke in patients with AF.Stent length(OR=2.012,1.318-3.723),diabetes mellitus(OR=2.531,1.574-3.928),smoking(OR=1.994,1.223-2.563),bifurcated lesions OR=3.127,2.327-5.223),Hcy(OR=2.018,1.579-2.336)were independent risk factors for stent restenosis with NVAF and ACS patients after PCI.Conclusions:1.Warfarin plus a P2Y12 receptor antagonist is an ideal antithrombotic regimen for patients with NVAF and ACS after PCI at high risk of stroke.2.CHA2DS2-VASc score combined with imaging and laboratory examination can better predict the risk of stroke in NVAF patients.Part II:Efficacy of Prasugrel Versus Clopidogrel in Patients with Non-valvular atrial fibrillation and acute coronary syndrome undergoing Percutaneous Coronary InterventionObjective:To analyse safety and efficacy of prasugrel with clopidogrel in Patients with Non-valvular atrial fibrillation(NVAF)and acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods:In this study,we prospectively analyzed the bleeding complications and mid-term(12 months)efficacy in 110 consecutive NVAF and ACS patients who underwent PCI and received warfarin plus prasugrel(prasugrel group),The comparison group consisted of 110 age-and gender-matched patients who received warfarin plus clopidogrel(clopidogrel group).Results:Although the incidence of bleeding complications in prasugrel group over 12 months was higher than that in clopidogrel group,the incidence of major bleeding complications and the cumulative incidence of major cardiovascular and cerebrovascular events(MACCEs)over 12 months was comparable between the prasugrel and clopidogrel groups(log-rank test;p=0.833).Conclusions:Prasugrel and clopidogrel may have similar efficacy for preventing cardiovascular and cerebrovascular events as the NVAF and ACS post-PCI;however,prasugrel should be used cautiously because of the risk of related bleeding complications.