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Abstract
Objective: To evaluate warfarin use in Chinese patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) by investigating the stroke and major adverse cardiac and cerebral events (MACCEs) and bleeding events.
Methods: Retrospective cohort study of the 5 year follow-up of 1134 patients with AF who underwent PCI. The patients were grouped according to whether they received warfarin or not. Baseline characteristics and the occurrence of MACCEs and bleeding events were compared between the two groups using the CHA2DS2-VASc and HAS-BLED scoring. Cox regression analysis was used to identify factors related to the occurrence of MACCEs and bleeding.
Results: Overall MACCE (p = .008) and mortality (p = .004) rates were significantly lower in the warfarin group compared with the non-warfarin group. Major bleeding, minor bleeding and overall bleeding were comparable in the two groups. Recurrent myocardial infarction (HR = 10.129, 95% CI = 4.737–21.655; p < .001) and a baseline CHA2DS2-VASc score >4 (HR = 2.035, 95% CI = 1.121–3.692; p = .019) were independent predictors of MACCEs in the warfarin group. A baseline HAS-BLED score ≥3 (HR = 5.498, 95% CI = 3.773–8.013; p < .001) and previous bleeding (HR = 3.058, 95% CI = 1.319–7.088; p = .009) were independent predictors of bleeding.
Conclusions: Warfarin reduces the incidence of MACCEs but does not increase bleeding events in Chinese patients with AF who underwent PCI. For patients taking warfarin, recurrent myocardial infarction and a baseline CHA2DS2-VASc score >4 were related to MACCE occurrence.
Transparency
Declaration of funding
This paper was funded by the National Key Research and Development Program of China (2017YFC0908800), the Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20150601) and Mission plan (SML20180601) and the Beijing Municipal Health Commission “Project of Science and Technology Innovation Center” (PXM2019_026272_000006 and PXM2019_026272_000005).
Author contributions
Y.L. conceived and designed the experiments, conducted the experiments, contributed the reagents/materials/analysis tools, prepared figures and/or tables, authored or reviewed the drafts of the paper, and approved the final draft. W.L. prepared figures and/or tables, authored or reviewed drafts of the paper, and approved the final draft. F.H. analyzed the data, authored or reviewed drafts of the paper, and approved the final draft. X.L. performed the experiments, authored or reviewed drafts of the paper, and approved the final draft. H.S. performed the experiments, authored or reviewed drafts of the paper, and approved the final draft. P.J. analyzed the data, authored or reviewed drafts of the paper, and approved the final draft. Z.X. analyzed the data, authored or reviewed drafts of the paper, and approved the final draft. Y.Z. conceived and designed the experiments, contributed reagents/materials/analysis tools, authored or reviewed drafts of the paper, and approved the final draft.
Declaration of financial/other relationships
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgements
None reported.