Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial

Lahtela, Heli; Kiviniemi, Tuomas; Puurunen, Marja; Schlitt, Axel; Rubboli, Andrea; Ylitalo, Antti; Valencia, José; Lip, Gregory Y.H.; Airaksinen, Juhani

doi:10.1371/journal.pone.0128492

Cited by 11 publications

(10 citation statements)

References 33 publications

(23 reference statements)

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“…However, the increased incidence of ischemic stroke in the CKD group (5.2% relative to 3.2% for non-CKD) proved to be attributable to other concomitant risk factors. In the AFCAS registry, renal dysfunction was independently associated with 1-y all-cause mortality and MACCE in patients with AF referred for PCI [17]. Our study confirmed this correlation on a long-term follow-up, and also identified CKD as an independent risk factor for BARC grade 2 or higher bleeding events.…”

Section: Resultssupporting

confidence: 84%

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Wang¹,

Ma²,

Zheng³

et al. 2018

biomedicalresearch

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Background: The effect of Chronic Kidney Disease (CKD) on the long-term prognosis of patients with Atrial Fibrillation (AF) undergoing coronary stenting was less studied. Methods: We enrolled 2,511 patients with non-valvular AF undergoing coronary stenting between January 2010 and June 2015 from 12 hospitals in Beijing, China. Results: 22.9% had CKD (creatinine clearance<60 ml/min). Compared to those with preserved renal function, patients with CKD were older, and had the higher prevalence of women, hypertension, previous ischemic stroke, cardiac dysfunction, and anemia. All patients were treated with drug-eluting stents. Dual antiplatelet therapy was the dominant antithrombotic strategy in both groups (96.0% vs. 93.9%, P=0.054). The follow-up duration was 39.5 ± 18.6 months. Complete follow-up data was obtained for 95.3% of this cohort. CKD group had higher incidences of death (19.0% vs. 6.9%, P<0.001), ischemic stroke (5.5% vs. 3.3%, P=0.020), MACCE (a composite of all-cause death, non-fatal myocardial infarction, target vessel revascularization, ischemic stroke and arterial thromboembolism, 28.2% vs. 14.7%, P<0.001) and Bleeding Academic Research Consortium (BARC) ≥ grade 3 (2.4% vs. 0.8%, P=0.003). No significant difference was noted with regard to myocardial infarction and target vessel revascularization. Cox multivariate regression identified CKD as an independent risk factor for allcause death (Hazard ratio (HR): 1.85, 95% CI: 1.37-2.50), MACCE (HR: 1.56, 95% CI: 1.25-1.96) and BARC ≥ 3 bleeding (HR: 3.14, 95% CI: 1.49-6.61), but not for ischemic stroke (HR: 1.10, 95% CI: 0.67-1.79). Conclusion: CKD was independently associated with poor long-term prognosis except for ischemic stroke in patients with AF and coronary stenting.

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Section: Resultssupporting

confidence: 84%

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Wang¹,

Ma²,

Zheng³

et al. 2018

biomedicalresearch

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show abstract

“…In this study, we identified heart failure and CKD as independent predictors of death in both younger and older patients. Renal dysfunction was independently associated with 1-year all-cause mortality and MACCE in patients with AF referred for PCI in the AFCAS (Atrial Fibrillation undergoing Coronary Artery Stenting) registry ( 28 ). One possible explanation is that CKD is often associated with other traditional cardiovascular risk factors.…”

Section: Discussionmentioning

confidence: 99%

Sex difference in clinical outcomes of Chinese patients with atrial fibrillation and coronary stenting according to age

Zheng

Chen

et al. 2020

Anatol J Cardiol

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Objective: Sex differences in the clinical outcomes of patients with atrial fibrillation (AF) and coronary stenting should be assessed according to age. Methods: We analyzed the clinical data of all patients with nonvalvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. Results: A total of 2,146 patients (71.8% men and 28.2% women) were included in the study. The mean age of the patients was 66.6±9.4 years. Women in this study were older and had higher prevalence of hypertension, diabetes, chronic kidney disease (CKD), and anemia. Smoking history was found to be higher in men, and women were less likely to be current smokers. The mean follow-up duration was 39.7 months. Women younger than 65 years had a remarkably higher mortality (11.2% vs. 5.3%, p=0.012) and a significantly lower rate of repeat revascularization (1.6% vs. 6.3%, p=0.034) than men. Female gender remained an independent predictor for all-cause mortality [hazard ratio (HR)=2.03, 95% confidence interval (CI): 1.09–3.79, p=0.025], along with heart failure (HR=3.64, 95% CI: 2.02–6.57, p<0.001) and CKD (HR=2.46, 95% CI: 1.09–5.57, p=0.031) after multivariate regression analysis. No significant difference was noted between men and women with regard to mortality, ischemic events, and major bleeding in elderly patients. Conclusion: In Chinese patients younger than 65 years with AF and coronary stenting, female gender was independently associated with increased mortality; men were more likely to receive repeat revascularization possibly due to the current smoking. Whether it was a biological difference or a recognition disparity of the disease between men and women warrants further investigation.

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“…There are only few studies concerning renal function in population with AF undergoing coronary angiography so the prevalence of CKD in patients with AF undergoing percutaneous coronary intervention (PCI) remains largely unknown [12]. While this is a clinically important issue because in patients with AF, CKD is associated with an increased risk of dangerous complications like ischaemic stroke, systemic emboli and bleedings [13].…”

Section: Introductionmentioning

confidence: 99%

Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery – a 867 Patient Study

Tomaszuk‐Kazberuk

Nikas

Łopatowska

et al. 2018

Kidney Blood Press Res

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Background/Aims: Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients’ outcome, the association between renal impairment and the type of coronary procedures in AF patients and the influence of renal function on in-hospital mortality. Methods: We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m² evaluated by CKD-EPI formula. Results: A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m² in patients with CKD and 89±18 ml/min./1.73m² in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKD patients CHA₂DS₂VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA₂DS₂VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKD patients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). Conclusion: Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients’ prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.

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Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial

Cited by 11 publications

References 33 publications

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Sex difference in clinical outcomes of Chinese patients with atrial fibrillation and coronary stenting according to age

Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery – a 867 Patient Study

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