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Outcomes of patients with periprocedural atrial fibrillation undergoing percutaneous coronary intervention for chronic total occlusion

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Abstract

Background

Successful CTO recanalization has been associated with clinical benefit. Outcomes of patients with atrial fibrillation undergoing CTO PCI have not been investigated, yet.

Aims

This study sought to evaluate the association between atrial fibrillation and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).

Methods

Consecutive patients undergoing CTO PCI between January 2005 and December 2013 were divided into patients with and without atrial fibrillation, and propensity-matched models used to adjust for baseline differences between groups. The primary outcome was all-cause mortality at a median follow-up of 3.2 (interquartile range 3.1–4.5) years.

Results

Of 2002 patients undergoing CTO PCI, atrial fibrillation was present in 169 (8.4%) patients. Patients with atrial fibrillation were older, and more frequently had hypertension, left ventricular systolic dysfunction, and chronic kidney disease. Before matching, all-cause mortality was 39.6 and 14.5% in the atrial fibrillation and the sinus rhythm groups (HR 2.92, 95% CI 2.23–3.82, p < 0.001). In the propensity-matched model, atrial fibrillation remained associated with an increased risk of mortality (HR 1.62, 95% CI 1.06–2.47, p = 0.03). In the unmatched patient cohort, all-cause mortality was significantly reduced in patients with procedural success, both in the atrial fibrillation (34.9 versus 55.0%, adjusted HR 0.99, 95% CI 0.97–1.00, p = 0.02) and the sinus rhythm groups (12.8 versus 23.0%, adjusted HR 0.70, 95% CI 0.53–0.92, p = 0.01).

Conclusions

Although atrial fibrillation is independently associated with mortality after CTO PCI, substantial survival benefit of successful CTO recanalization is observed in both patients with and without atrial fibrillation.

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References

  1. Go AS, Hylek EM, Phillips KA et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375

    Article  CAS  PubMed  Google Scholar 

  2. Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946–952

    Article  CAS  PubMed  Google Scholar 

  3. Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 22:983–988

    Article  CAS  PubMed  Google Scholar 

  4. Rathore SS, Berger AK, Weinfurt KP et al (2000) Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 101:969–974

    Article  CAS  PubMed  Google Scholar 

  5. Andersson T, Magnuson A, Bryngelsson IL et al (2013) All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case-control study. Eur Heart J 34:1061–1067

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stamou SC, Dangas G, Hill PC et al (2000) Atrial fibrillation after beating heart surgery. Am J Cardiol 86:64–67

    Article  CAS  PubMed  Google Scholar 

  7. McAlister FA, Jacka M, Graham M et al (2015) The prediction of postoperative stroke or death in patients with preoperative atrial fibrillation undergoing non-cardiac surgery: a VISION sub-study. J Thromb Haemost 13:1768–1775

    Article  CAS  PubMed  Google Scholar 

  8. Zusman O, Amit G, Gilutz H, Zahger D (2012) The significance of new onset atrial fibrillation complicating acute myocardial infarction. Clin Res Cardiol 101:17–22

    Article  PubMed  Google Scholar 

  9. Fefer P, Knudtson ML, Cheema AN et al (2012) Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol 59:991–997

    Article  PubMed  Google Scholar 

  10. Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR (2005) Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol 95:1088–1091

    Article  PubMed  Google Scholar 

  11. Kato M, Kimura T, Morimoto T et al (2012) Comparison of five-year outcome of sirolimus-eluting stent implantation for chronic total occlusions versus for non-chronic total occlusion (from the j-Cypher registry). Am J Cardiol 110:1282–1289

    Article  CAS  PubMed  Google Scholar 

  12. George S, Cockburn J, Clayton TC et al (2014) Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database. J Am Coll Cardiol 64:235–243

    Article  PubMed  Google Scholar 

  13. Suero JA, Marso SP, Jones PG et al (2001) Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol 38:409–414

    Article  CAS  PubMed  Google Scholar 

  14. Mehran R, Claessen BE, Godino C et al (2011) Long-term outcome of percutaneous coronary intervention for chronic total occlusions. J Am Coll Cardiol Cardiovasc Interv 4:952–961

    Article  Google Scholar 

  15. Hoebers LP, Claessen BE, Elias J, Dangas GD, Mehran R, Henriques JP (2015) Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome. Int J Cardiol 187:90–96

    Article  PubMed  Google Scholar 

  16. Toma A, Gick M, Minners J et al (2016) Survival after percutaneous coronary intervention for chronic total occlusion. Clin Res Cardiol 105:921–929

    Article  CAS  PubMed  Google Scholar 

  17. Sutton NR, Seth M, Ruwende C, Gurm HS (2016) Outcomes of patients with atrial fibrillation undergoing percutaneous coronary intervention. J Am Coll Cardiol 68:895–904

    Article  PubMed  Google Scholar 

  18. Bramlage P, Cuneo A, Zeymer U et al (2013) Prognosis of patients with atrial fibrillation undergoing percutaneous coronary intervention receiving drug eluting stents. Clin Res Cardiol 102:289–297

    Article  CAS  PubMed  Google Scholar 

  19. Rohla M, Vennekate CK, Tentzeris I et al (2015) Long-term mortality of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation for acute and stable coronary artery disease. Int J Cardiol 184:108–114

    Article  PubMed  Google Scholar 

  20. Toma A, Stahli BE, Gick M et al (2016) Long-term follow-up of patients with previous coronary artery bypass grafting undergoing percutaneous coronary intervention for chronic total occlusion. Am J Cardiol 118:1641–1646

    Article  PubMed  Google Scholar 

  21. Toma A, Gebhard C, Gick M et al (2017) Survival after percutaneous coronary intervention for chronic total occlusion in elderly patients. EuroIntervention 13:e228–e235

    Article  PubMed  Google Scholar 

  22. Stahli BE, Gebhard C, Gick M et al (2016) Impact of body mass index on long-term mortality in women and men undergoing percutaneous coronary intervention for chronic total occlusion. Int J Cardiol 224:305–309

    Article  PubMed  Google Scholar 

  23. Toma A, Stahli BE, Gick M et al (2017) Impact of multi-vessel versus single-vessel disease on outcomes after percutaneous coronary interventions for chronic total occlusions. Clin Res Cardiol 106:428–435

    Article  PubMed  Google Scholar 

  24. Chan W, Ajani AE, Clark DJ et al (2012) Impact of periprocedural atrial fibrillation on short-term clinical outcomes following percutaneous coronary intervention. Am J Cardiol 109:471–477

    Article  PubMed  Google Scholar 

  25. Lopes RD, Elliott LE, White HD et al (2009) Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention: results from the APEX-AMI trial. Eur Heart J 30:2019–2028

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sianos G, Werner GS, Galassi AR et al (2012) Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 8:139–145

    Article  PubMed  Google Scholar 

  27. Ahmed A, Rich MW, Love TE et al (2006) Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J 27:178–186

    Article  CAS  PubMed  Google Scholar 

  28. Gunawardene M, Willems S, Schaffer B et al (2017) Influence of periprocedural anticoagulation strategies on complication rate and hospital stay in patients undergoing catheter ablation for persistent atrial fibrillation. Clin Res Cardiol 106:38–48

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Charité Berlin, University Medicine, Campus Benjamin Franklin, Berlin, Germany

    Barbara E. Stähli

  2. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany

    Cathérine Gebhard, Michael Gick, Kambis Mashayekhi, Miroslaw Ferenc, Heinz Joachim Buettner, Franz-Josef Neumann & Aurel Toma

Authors
  1. Barbara E. Stähli
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  2. Cathérine Gebhard
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  3. Michael Gick
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  4. Kambis Mashayekhi
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  5. Miroslaw Ferenc
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  6. Heinz Joachim Buettner
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  7. Franz-Josef Neumann
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  8. Aurel Toma
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Correspondence to Aurel Toma.

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Stähli, B.E., Gebhard, C., Gick, M. et al. Outcomes of patients with periprocedural atrial fibrillation undergoing percutaneous coronary intervention for chronic total occlusion. Clin Res Cardiol 106, 986–994 (2017). https://doi.org/10.1007/s00392-017-1148-4

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  • DOI: https://doi.org/10.1007/s00392-017-1148-4

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