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Comparison of mid-term outcomes between patients with and without atrial fibrillation undergoing coronary stenting in the second-generation drug-eluting stent era: from the SHINANO registry

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Abstract

Little is known about the mid-term outcomes of patients with atrial fibrillation (AF) who undergo coronary stenting in the second-generation drug-eluting stent (DES) era. We evaluated the 1-year outcomes of AF patients undergoing percutaneous coronary intervention (PCI) with second-generation DES. This retrospective cohort analysis used integrated data from the SHINANO registry, a prospective observational multicenter cohort study, which enrolled 1923 consecutive patients undergoing PCI for any coronary artery disease. We retrospectively recruited 917 of these patients (mean age, 71.3 ± 10.0 years; male, 77 %) who received PCI with 2nd generation DES. The primary endpoint was net adverse clinical events (NACE: cardiac death, stroke, MI, stent thrombosis, and major bleeding) at 1 year. The secondary endpoints were major adverse cardiovascular events (MACE: cardiac death, stroke, and MI), stroke, MI, and major bleeding at 1 year. One-year follow-up was completed in 871 (94.9 %) patients, of whom 85 had AF. The incidence of NACE (15.4 vs. 7.3 %, P = 0.008), MACE (10.6 vs. 5.4 %, P = 0.047), and major bleeding (6.0 vs. 2.3 %, P = 0.049) were all significantly higher in AF compared to non-AF patients. On multivariate analysis, AF was an independent predictor of NACE (HR 2.32, 95 % CI 1.24–4.34, P = 0.008). In the second-generation DES era, patients with AF undergoing PCI still have a poorer prognosis, with more thrombotic and bleeding events, than those without AF. More attention should be paid to the thrombotic and bleeding risk in AF patients undergoing PCI.

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Abbreviations

AF:

Atrial fibrillation

PCI:

Percutaneous coronary intervention

CAD:

Coronary artery disease

DES:

Drug-eluting stent(s)

DAPT:

Dual antiplatelet therapy

OAC:

Oral anticoagulants

STEMI:

ST-segment elevation myocardial infarction

NSTEMI:

Non-ST-segment elevation myocardial infarction

UA:

Unstable angina

MACE:

Major adverse cardiovascular events

MI:

Myocardial infarction

NACE:

Net adverse clinical events

ACS:

Acute coronary syndrome

TIMI:

Thrombolysis In Myocardial Infarction

CK:

Creatine kinase

HF:

Heart failure

BP:

Blood pressure

LVEF:

Left ventricular ejection fraction

eGFR:

Estimated glomerular filtration rate (Cockcroft–Gault)

PAD:

Peripheral artery disease

CTO:

Chronic total occlusion

BMS:

Bare-metal stent(s)

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Acknowledgments

We appreciate the supports of the co-investigators participating in the Shinano-registry.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Shinshu University School of Medicine, 1-1-3 Asahi, Matsumoto, 390-8621, Japan

    Takashi Miura, Yusuke Miyashita, Hirohiko Motoki, Naoto Hashizume, Soichiro Ebisawa, Atsushi Izawa, Jun Koyama & Uichi Ikeda

  2. Department of Cardiology, Shinshu Ueda Medical Center, Ueda, Japan

    Hideki Kobayashi

  3. Department of Cardiology, Matsumoto Kyoritsu Hospital, Matsumoto, Japan

    Masanori Kobayashi

  4. Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan

    Hiroyuki Nakajima & Takehiro Morita

  5. Department of Cardiology, Saku Central Hospital, Saku, Japan

    Hikaru Kimura

  6. Department of Cardiology, Iida Municipal Hospital, Iida, Japan

    Hiroshi Akanuma

  7. Department of Cardiology, Kita Alps Medical Center, Azumino, Japan

    Eiichiro Mawatari

  8. Department of Cardiology, Shinonoi General Hospital, Nagano, Japan

    Toshio Sato & Takuya Maruyama

  9. Department of Cardiology, Ina Central Hospital, Ina, Japan

    Shoji Hotta

  10. Department of Cardiology, Aizawa Hospital, Matsumoto, Japan

    Yuichi Kamiyoshi & Shinichi Aso

  11. Department of Cardiology, Hokushin General Hospital, Nakano, Japan

    Noboru Watanabe

  12. Department of Cardiology, Komoro Kosei General Hospital, Komoro, Japan

    Takayuki Eizawa

  13. Department of Cardiology, Azumino Red Cross Hospital, Azumino, Japan

    Shinichiro Uchikawa

  14. Department of Cardiology, Okaya Municipal Hospital, Okaya, Japan

    Keisuke Senda

Authors
  1. Takashi Miura
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  2. Yusuke Miyashita
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  3. Hirohiko Motoki
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  4. Hideki Kobayashi
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  5. Masanori Kobayashi
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  6. Hiroyuki Nakajima
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  7. Hikaru Kimura
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  8. Hiroshi Akanuma
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  9. Eiichiro Mawatari
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  10. Toshio Sato
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  11. Shoji Hotta
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  12. Yuichi Kamiyoshi
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  13. Takuya Maruyama
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  14. Noboru Watanabe
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  15. Takayuki Eizawa
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  16. Shinichi Aso
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  17. Shinichiro Uchikawa
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  18. Naoto Hashizume
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  19. Keisuke Senda
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  20. Takehiro Morita
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  21. Soichiro Ebisawa
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  22. Atsushi Izawa
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  23. Jun Koyama
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  24. Uichi Ikeda
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Corresponding author

Correspondence to Takashi Miura.

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Conflict of interest

None of the authors has a real or perceived conflict of interest regarding the work presented in this manuscript.

Human right statement

Written informed consents were obtained from all the study patients.

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Miura, T., Miyashita, Y., Motoki, H. et al. Comparison of mid-term outcomes between patients with and without atrial fibrillation undergoing coronary stenting in the second-generation drug-eluting stent era: from the SHINANO registry. Cardiovasc Interv and Ther 32, 206–215 (2017). https://doi.org/10.1007/s12928-016-0406-0

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  • DOI: https://doi.org/10.1007/s12928-016-0406-0

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