Epidemiological Investigation Of Patients With NVAF Complicated With ACS Undergoing PCI And A Long-term Follow-up Study Using Different Antithrombotic Regimens

Objective:It is a difficult problem to balance the risk of bleeding and embolism for antithrombotic therapy after PCI in patients with atrial fibrillation complicated with acute coronary syndrome(ACS).This study is a larger cross-sectional retrospective study in the world.During the period of this data collection,the treatment in this field was relatively chaotic in China.During this period,there were a number of different versions of relevant guidelines published internationally.This study aims to clarify the treatment status and prognosis of patients with NVAF complicated with ACS undergoing PCI and provide a more safe and effective treatment scheme for clinical treatment.Methods:1.A total of 2,285 patients with atrial fibrillation and ACS undergoing percutaneous coronary intervention in 12 grade A hospitals in Beijing within 5 years were collected and followed up.The incidence,treatment,risk factors,adverse cardiovascular events(MACCE)and BARC bleeding events of these patients were statistically analyzed.A total of 654 patients were enrolled in the bigeminal group of warfarin combined with aspirin or clopidogrel and the trigeminal group of warfarin combined with aspirin and clopidogrel for a duration of more than 24 months,and the adverse events after discharge were compared between different antithrombotic treatment regimens.ROC curve was used to evaluate the predictive power of each score on MACCE events during the follow-up period,and the area under the curve(AUC)was used as the evaluation index.2.90 patients with NVAFcomplicated with ACS after PCI in the people’s hospital of Inner Mongolia autonomous region were randomly selected and divided into three groups according to different antithrombotic regimens after discharge,namely triple antithrombotic group,double antithrombotic group and warfarin combined monoclonal antibody group.Clinical endpoint events were recorded and statistically analyzed at 12 months of follow-up.Results:1.Age of patients(OR:1.34,95%CI:1.05～1.72),length of stay(OR:1.37,95%CI:1.16~1.61),hypertension history(OR:1.71,95%CI:1.52~1.97),History of PCI(OR:1.38,95%CI:1.02~1.87),stroke history(OR:1.74,95%CI:1.31~2.32),cardiac insufficiency(OR:1.82,95%CI:1.58~2.17),ejection fraction(OR:1.94,95%CI:1.28~2.95),Electrocardiogram ST segment elevation(OR:1.76,95%CI:1.27~2.45)And the ecg ST segment decreased(OR:1.69,95%CI:1.48~1.99)were significantly associated with the occurrence of MACCE events during patient follow-upo。The patient had previous PCI(OR:1.42,95%CI:1.13~1.81),Platelet count(OR:1.73,95%CI:1.39~2.48),Leukocyte count(OR:1.69,95%CI:1.10~1.79),Potassium levels(OR:1.54,95%CI:1.15~1.97),urine occult blood(OR:1.44,95%CI:1.11~1.83)and the number of stents implanted(OR:1.89,95%CI:1.45~2.54)These were significantly correlated with the occurrence of BARC bleeding events during the follow-up,and the results were all statistically significant(P<0.05).There were no significant differences in survival analysis,all-cause death and MACCE events between the bimodal group and trigeminal group over 24 months,and there was significant difference in BARC bleeding events.There was no significant difference in AUC values of MACCE events predicted by different scoring methods.2.60%of patients CHA2DS2-VAScscoring≥2,49%of patients HAS-BLED scoring≥3,The results showed that the overall risk of stroke was higher and the risk of bleeding was similar in the enrolled patients,but the differences among the three groups were not statistically significant(P>0.05).The incidence of MACCE was the lowest in the triad group(6.7%),and there was no significant difference among the three groups.In addition,the incidence of BARC hemorrhage was higher in the triad group(23.3%),and the difference among the three groups was statistically significant.Conclusion:the prognosis of patients with nvaf complicated with ACS undergoing PCI is related to many risk factors.There is no significant difference in all-cause death and MACCE events,but there is a significant difference in BARC bleeding events.Therefore,different antithrombotic schemes should be selected carefully.