Predictive models for adverse clinical outcomes in Chinese patients with atrial fibrillation undergoing percutaneous coronary intervention with stenting

Abstract

Objective

This study aimed to evaluate predictors for adverse cardiovascular outcomes in patients with atrial fibrillation (AF) undergoing coronary stenting.

Methods

We retrospectively recruited consecutive patients with previously documented non-valvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. Major adverse cardiac/cerebrovascular events (MACCE) were a composite of all-cause death, non-fatal myocardial infarction, repeat revascularization, and ischaemic stroke/systemic thromboembolism (IS/STE). Major bleeding referred to grade 2 or higher of Bleeding Academic Research Consortium criteria.

Results

A total of 2394 patients (men: 72.3% vs. women: 27.7%, median age: 67 years) were included. The CHA₂DS₂-VASc and HAS-BLED were 3.6 ± 1.6 and 1.9 ± 0.7, respectively. The median follow-up duration was 36.2 months. There were 230 (9.6%) deaths, 96 (4.0%) IS/STE, 426 (17.8%) MACCE, and 72 (3.0%) major bleeding. Multivariate Cox regression yielded predictive models for (1) all-cause death: diabetes, prior myocardial infarction, chronic kidney disease (CKD), ST-segment elevation myocardial infarction (STEMI) at presentation, heart failure, no use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins; (2) IS/STE: advanced age, prior history of ischaemic stroke and intracranial haemorrhage; (3) MACCE: prior history of myocardial infarction and ischaemic stroke, CKD, STEMI, heart failure, and no statin use; (4) major bleeding: prior major bleeding, prior myocardial infarction, CKD and use of oral anticoagulants.

Conclusion

Chinese patients with AF and coronary stenting had high mortality and incidence of MACCE. We compiled separate predictive models for all-cause death, IS/STE, MACCE, and major bleeding.

Keywords:

• Atrial fibrillation
• percutaneous coronary intervention

Acknowledgments

The authors sincerely thank Prof. Yun-Dai Chen M.D. of PLA General Hospital, Dang-Sheng Huang M.D. of Fourth Medical Center of PLA General Hospital, Yun-Tian Li M.D. of PLA 305 Hospital, Shou-Li Wang M.D. of PLA 306 Hospital, Yan-Yan Chu M.D. of Beijing Xuanwu Hospital, Shi Guo M.D. of Beijing Dongzhimen Hospital, and Yu-Ling Niu M.D. of Beijing Fangshan First Hospital for participating in and supporting this study.

Disclosure statement

The authors declared no conflict of interest.

Additional information

Funding

This work was supported by Chinese PLA General Hospital under Grant number: 2019MBD-057 and Beijing Municipal Science and Technology Commission under Grant number: Z151100004015205.