PROGNOSTIC MARKERS OF ISCHEMIC AND HEMORRHAGIC COMPLICATIONS IN PATIENTS WITH ATRIAL FIBRILLATION AFTER PERCUTANEOUS CORONARY INTERVENTION.

Abstract

Background and objectives: Patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) are at high risk for ischemic and hemorrhagic complications. This study aimed to identify predictors of these complications to optimize risk assessment and management.

Materials and methods: A retrospective analysis of 92 ACS patients with AF who underwent PCI at Semey Emergency Hospital (2022-2023) was conducted. Patients were followed for one year, and ischemic (myocardial infarction [MI], stroke, stent thrombosis, revascularization, and mortality) and hemorrhagic (BARC types 3 and 5 bleeding) events were recorded. Logistic regression and receiver operating characteristic (ROC) analyses identified significant risk factors.

Results: Ischemic events occurred in 23 patients (25%), including MI (56.5%) and stroke (34.8%). Hemorrhagic events occurred in 14 patients (15.2%), with gastrointestinal bleeding (50%) and hemorrhagic stroke (35.7%) being most common. One-year mortality was 22.8%. Predictors of ischemic events included MI history, reduced left ventricular ejection fraction, elevated pro-brain natriuretic peptide, creatinine, and platelet count, and decreased estimated glomerular filtration rate (p<0.001). Predictors of hemorrhagic events included male sex, smoking, peptic ulcer disease, anticoagulant use, low hemoglobin, and elevated international normalized ratio and prothrombin time (p<0.05).

Conclusions: Identifying ischemic and hemorrhagic risk factors allows for personalized therapy in ACS patients with AF after PCI, reducing complications and improving outcomes.