Prevalence and Determinants of Atrial Fibrillation-Associated In-Hospital Ischemic Stroke in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Patil, Shivaraj; Gonuguntla, Karthik; Rojulpote, Chaitanya; Kumar, Manish; Nadadur, Srinivas; Nardino, Robert J.; Pickett, Chris A

doi:10.1016/j.amjcard.2020.12.066

Cited by 6 publications

(2 citation statements)

References 20 publications

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“…A history of MI, one of the factors associated with ischemic events in the present study, may indicate a history of PCI or coronary artery bypass graft, which are also considered risk factors for thrombosis by the JCS [ 5 ]. Furthermore, the use of anticoagulants may imply the existence of atrial fibrillation, which is another ischemic risk factor in patients undergoing PCI [ 20 , 21 ]. This result suggests that in patients with high bleeding risk, DAPT duration < 3 months may be insufficient to prevent ischemic events, particularly in patients at high ischemic risk.…”

Section: Discussionmentioning

confidence: 99%

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Yokoi

Oda²,

Kaneko³

et al. 2022

Cardiovasc Interv and Ther

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In this real-world, retrospective cohort study of 9753 patients in Japan prescribed dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), we investigated DAPT duration and determined factors associated with early DAPT discontinuation and with event rates in patients who discontinued DAPT. The study period was April 1, 2012–March 31, 2018; endpoints comprised composite efficacy [death, myocardial infarction (MI), and stroke] and bleeding (intracranial, gastrointestinal, and requiring transfusion) endpoints. Overall, 68.8% of patients were continuing DAPT at 3 months post-PCI. Patients without major efficacy or safety events within 3 months after index PCI were included in a landmark analysis set (LAS; n = 7056), and categorized as DAPT ≥ 3 months (continuation) versus < 3 months (discontinuation). In the two LAS analysis groups, there was no difference in the composite bleeding endpoint (P = 0.067), although the incidence of the composite efficacy endpoint was higher in the discontinuation group (P < 0.001). In multivariate regression analysis, age ≥ 75 years, minor bleeding after PCI, history of cerebral infarction, history of cerebral or gastrointestinal bleeding, atrial fibrillation, dialysis, and anticoagulant use after PCI were associated with early DAPT discontinuation. Acute coronary syndrome, history of MI, kidney disorder, and anticoagulant use after PCI were associated with the composite efficacy endpoint in the discontinuation group. In conclusion, early DAPT discontinuation is more likely in patients at high bleeding risk, but may influence the occurrence of ischemic events in these patients. Determination of DAPT duration should take into account potential ischemic risk, even in patients at high bleeding risk.

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Section: Discussionmentioning

confidence: 99%

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Yokoi

Oda²,

Kaneko³

et al. 2022

Cardiovasc Interv and Ther

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“…While the majority of the data supporting these findings derive from patients undergoing coronary intervention in the setting of acute coronary syndrome (ACS)—including both non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI), data regarding patients with AF undergoing coronary intervention in the setting of anticoagulation therapy is scarce [ 6 ]. Patients with AF undergoing PCI are more likely to experience adverse outcomes, including in-hospital stroke, compared to those without AF [ 7 ]. Moreover, in the recently published SAFARI-STEMI study, there was a trend towards an increased stroke rate in the TRA group compared to the TFA group, with an RR of 2.24.…”

Section: Introductionmentioning

confidence: 99%

Impact of Access Site on Periprocedural Bleeding and Cerebral and Coronary Events in High-Bleeding-Risk Percutaneous Coronary Intervention: Findings from the RIVA-PCI Trial

Borlich,

Zeymer,

Wienbergen

et al. 2023

Cardiol Ther

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Introduction The preference for using transradial access (TRA) over transfemoral access (TFA) in patients requiring percutaneous coronary intervention (PCI) is based on evidence suggesting that TRA is associated with less bleeding and fewer vascular complications, shorter hospital stays, improved quality of life, and a potential beneficial effect on mortality. We have limited study data comparing the two access routes in a patient population with atrial fibrillation (AF) undergoing PCI, who have a particular increased risk of bleeding, while AF itself is associated with an increased risk of thromboembolism. Methods Using data from the RIVA-PCI registry, which includes patients with AF undergoing PCI, we analyzed a high-bleeding-risk (HBR) cohort. These patients were predominantly on oral anticoagulants (OAC) for AF, and the PCI was performed via radial or femoral access. Endpoints examined were in-hospital bleeding (BARC 2–5), cerebral events (TIA, hemorrhagic or ischemic stroke) and coronary events (stent thrombosis and myocardial infarction). Results Out of 1636 patients, 854 (52.2%) underwent TFA, while 782 (47.8%) underwent the procedure via TRA, including nine patients with brachial artery puncture. The mean age was 75.5 years. Groups were similar in terms of age, sex distribution, AF type, cardiovascular history, risk factors, and comorbidities, except for a higher incidence of previous bypass surgeries, heart failure, hyperlipidemia, and chronic kidney disease (CKD) with a glomerular filtration rate (GFR) < 60 ml/min in the TFA group. No clinically relevant differences in antithrombotic therapy and combinations were present at the time of PCI. However, upon discharge, transradial PCI patients had a higher rate of triple therapy, while dual therapy was preferred after transfemoral procedures. Radial access was more frequently chosen for non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP) cases (NSTEMI 26.6% vs. 17.0%, p < 0.0001; UAP 21.5% vs. 14.5%, p < 0.001), while femoral access was more common for elective PCI (60.3% vs. 44.1%, p < 0.0001). No differences were observed for ST-segment elevation myocardial infarction (STEMI). Both groups had similar rates of cerebral events (TFA 0.2% vs. TRA 0.3%, p = 0.93), but the TFA group had a higher incidence of bleeding (BARC 2–5) (4.2% vs. 1.5%, p < 0.01), mainly driven by BARC 3 bleeding (1.5% vs. 0.4%, p < 0.05). No significant differences were found for stent thrombosis and myocardial infarction (TFA 0.2% vs. TRA 0.3%, p = 0.93; TFA 0.4% vs. TRA 0.1%, p = 0.36). Conclusions In HBR patients with AF undergoing PCI for acute or chronic coronary syndrome, the use of TRA might be associated with a decrease in in...

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Impact of Access Site on Periprocedural Bleeding, Cerebrovascular, and Coronary Events in High-Bleeding-Risk Percutaneous Coronary Intervention: Findings from the RIVA-PCI Trial

Borlich¹,

Zeymer²,

Wienbergen³

et al. 2023

Preprint

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Background: The preference for using transradial access (TRA) over transfemoral access (TFA) in patients requiring coronary intervention is based on evidence suggesting that TRA is associated with less bleeding and vascular complications, shorter hospital stays, improved quality of life, and a potential beneficial effect on mortality. We have limited study data comparing both access routes in a patient population with atrial fibrillation undergoing PCI, who have a particular increased risk of bleeding, while AF itself is associated with an increased risk of thromboembolism. Methods: Using data from the RIVA-PCI registry, which includes atrial fibrillation patients undergoing PCI, we analyzed a high-bleeding-risk cohort. These patients were predominantly on oral anticoagulation (OAC) for atrial fibrillation and the PCI was performed via radial or femoral access. Endpoints examined were in-hospital bleeding (BARC 2-5), cerebral events (TIA, hemorrhagic or ischemic stroke) and coronary events (stent thrombosis and myocardial infarction). Results: Out of 1636 patients, 854 (52.2%) underwent transfemoral access (TFA), while 782 (47.8%) received the procedure via transradial access (TRA), including nine patients with brachial artery puncture. Mean age was 75.5 years. Groups were similar in terms of age, sex distribution, atrial fibrillation type, cardiovascular history, risk factors, and comorbidities, except for a higher incidence of previous bypass surgeries, heart failure, hyperlipidemia, and chronic kidney disease (CKD) with GFR<60 ml/min in the TFA group. Clinically relevant differences in antithrombotic therapy and combinations at the time of PCI were absent. However, upon discharge, transradial PCI patients had a higher rate of triple therapy, while dual therapy was preferred after transfemoral procedures. Radial access was more frequently chosen for non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP) cases (NSTEMI 26.6% vs. 17.0%, p<0.05; UAP 21.5% vs. 14.5%, p<0.05), while femoral access was more common for elective PCI (60.3% vs. 44.1%, p<0.05). No differences were observed for ST-segment elevation myocardial infarction (STEMI). Both groups had similar rates of cerebral events (TFA 0.2% vs. TRA 0.3%, p=0.93), but TFA group had a higher incidence of bleeding (BARC 2-5) (4.2% vs. 1.5%, p<0.05), mainly driven by BARC 3 bleeding (1.5% vs. 0.4%, p<0.05). No significant differences were found for stent thrombosis and myocardial infarction (TFA 0.2% vs. TRA 0.3%, p=0.93; TFA 0.4% vs. TRA 0.1%, p=0.36). Conclusions: In high bleeding risk (HBR) patients with atrial fibrillation (AF) undergoing PCI for acute or chronic coronary syndrome, utilizing radial access (TRA) resulted in a significant decrease of in-hospital bleeding, while not increasing the risk of embolic or ischemic events compared to femoral access.

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Prevalence and Determinants of Atrial Fibrillation-Associated In-Hospital Ischemic Stroke in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Cited by 6 publications

References 20 publications

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Impact of Access Site on Periprocedural Bleeding and Cerebral and Coronary Events in High-Bleeding-Risk Percutaneous Coronary Intervention: Findings from the RIVA-PCI Trial

Impact of Access Site on Periprocedural Bleeding, Cerebrovascular, and Coronary Events in High-Bleeding-Risk Percutaneous Coronary Intervention: Findings from the RIVA-PCI Trial

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