Outcome after coronary artery bypass surgery and percutaneous coronary intervention in patients with atrial fibrillation and oral anticoagulation

Figures & data

Table I. Baseline characteristics and operative data on patients with chronic oral anticoagulation for atrial fibrillation who underwent isolated coronary artery bypass surgery and percutaneous coronary intervention.

	CABG group (121 patients)	PCI group (301 patients)	P value
Age (years)	69.8 ± 8.5	72.9 ± 7.7	< 0.001
Age ≥ 80 years	11 (9.1%)	58 (19.3%)	< 0.001
Females	19 (15.7%)	79 (26.2%)	0.020
Diabetes	46 (38.0%)	92 (30.6%)	0.140
Hypertension	83 (68.6%)	236 (78.4%)	0.034
Stroke or transient ischemic attack	19 (15.7%)	65 (21.6%)	0.170
Prior percutaneous coronary intervention	18 (14.9%)	51 (16.9%)	0.604
Prior cardiac surgery	2 (1.7%)	48 (15.9%)	< 0.001
Acute coronary syndrome	26 (21.5%)	162 (53.8%)	< 0.001
Two- or three-vessel disease	115 (95.0%)	181 (60.2%)	< 0.001
Left main stenosis	39 (32.2%)	21 (7.0%)	< 0.001
Left ventricular ejection fraction < 30%	6 (5.0%)	14 (4.7%)	1.000
Preoperative INR	1.9 ± 0.6	2.3 ± 0.6	0.067
Off-pump surgery	43 (35.5%)	–
At least one mammary artery graft	115 (95.0%)	–
Maze procedure, n	10 (8.2%)	–
Distal anastomoses	3.1 ± 1.0	–
Vessels treated by PCI, n	–	1.1 ± 0.3
Patients treated with drug-eluting stent	–	73 (24.3%)
CHADS2 score	2.0 ± 1.2	2.1 ± 1.2	0.613
Drug treatment at discharge:
Aspirin	59 (49.6%)	275 (91.4%)	< 0.001
Clopidogrel	8 (6.8%)	291 (96.7%)	< 0.001
Statin	88 (73.9%)	262 (89.1%)	< 0.001
β-Blockers	110 (93.2%)	257 (87.4%)	0.088

Continuous variables are reported as mean ± standard deviation. Values in parentheses are percentages.

INR = international normalized ratio.

Table II. Outcome after coronary artery bypass surgery and percutaneous coronary intervention in patients on chronic oral anticoagulation for atrial fibrillation.

	CABG group (121 patients)	PCI group (301 patients)	P value
30-day outcome:
Mortality	4 (3.3)	7 (2.3)	0.520
Stroke	3 (2.5)	1 (0.7)	0.145
Repeat revascularization	0 (0)	3 (1.0)	0.561
Myocardial infarction	2 (1.7)	5 (1.7)	1.000
Major bleeding	3 (2.5)	12 (4.0)	0.570
3-year outcome:
Overall survival	86.4%	72.0%	0.006
Freedom from stroke^a	94.8%	94.9%	0.711
Freedom from myocardial infarction	93.8%	83.4%	0.008
Freedom from repeat revascularization	98.2%	85.3%	< 0.001
Freedom from major bleeding^a,b	88.7%	89.3%	0.823
Freedom from MACCE	78.9%	57.4%	< 0.001

Values in parentheses are percentages.

^aAlso events before discharge included.

^bIncludes three cases of pericardial tamponade that occurred immediately after CABG and one immediately after PCI.

MACCE = major adverse cardiac and cerebrovascular events defined as all-cause mortality, stroke, myocardial infarction and repeat revascularization (either percutaneous coronary intervention or coronary artery bypass grafting).

Table III. Bleeding episodes after coronary revascularization in patients on warfarin treatment for atrial fibrillation.

	CABG group (121 patients)	PCI group (301 patients)
30-day events:
Cardiac tamponade, operated	3	1
Access site bleeding, operated	–	4
Intracranial bleeding	–	3
Gastrointestinal bleeding	–	2
Airway bleeding	–	1
Late events:
Gastrointestinal bleeding	4	8
Airway bleeding	1	2
Intracranial bleeding	4	2
Vitreous bleeding	–	1
Hemarthron	2	–
Urinary tract bleeding	1	2

CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention.

Figure 1. Propensity score adjusted Cox's estimates of overall survival in patients on warfarin treatment for atrial fibrillation after isolated coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI).

Figure 2. Propensity score adjusted Cox's estimates of freedom from major cardiac and cerebrovascular events (MACCE) in patients on warfarin treatment for atrial fibrillation after isolated coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI).