抗凝疗法类型对冠状动脉分叉病变和心房颤动患者长期临床疗效的影响--来自保加利亚分叉注册中心的启示

Q4 Medicine
Medicina Pub Date : 2024-08-10 DOI:10.3390/medicina60081294
Niya Mileva, Dobrin Vassilev, Panayot Panayotov, Pavel Nikolov, Georgi Dimitrov, Kiril Karamfiloff, Gianluca Rigatelli, Robert J. Gil
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引用次数: 0

摘要

背景和目标:心房颤动和冠状动脉疾病患者是死亡率风险较高的群体。目的:评估心房颤动(房颤)合并明显冠状动脉分叉病变的患者,并比较使用维生素 K 拮抗剂(VKA)进行抗凝治疗的患者与使用直接抗凝剂(DOAC)的患者的临床疗效。材料与方法:这是一项前瞻性研究,研究对象为房颤和稳定型冠状动脉疾病患者,这些患者均有证据表明冠状动脉分叉病变严重。采用对数秩检验评估服用 VKA 和 DOAC 患者之间死亡率的差异。主要终点是中期全因死亡和心血管死亡的发生率。研究结果共纳入226名房颤且有明显分叉病变的患者。平均年龄为(70.9±9.2)岁,70%为男性。其中 123 人(54.7%)正在接受 VKA 治疗,103 人(45.3%)正在服用 DOAC。中位随访时间为 55 (39-96) 个月,总死亡率为 40%,心血管疾病死亡率为 31%。服用 DOAC 的患者的全因死亡率(28.2% 对 50.4%,P = 0.020)和 CV 死亡率(12.7% 对 24.9%,P = 0.032)均显著低于服用 VKA 的患者。在接受 PCI 治疗的患者中,服用 DOAC 的患者的 CV 死亡率明显降低(21.4% 对 40.5%,p = 0.032)。VKA 治疗是心血管死亡的独立预测因素(HR 1.88;95% CI 1.11-3.18;p = 0.01),同时也是慢性肾病的独立预测因素(HR 1.81;95% CI 1.13-2.92;p = 0.01)。结论心房颤动和冠状动脉分叉病变患者接受 DOAC 治疗后,死亡率显著降低,与治疗方法无关。VKA是预测心血管疾病死亡率的独立因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of the Type of Anticoagulation Therapy on Long-Term Clinical Outcomes in Patients with Coronary Bifurcation Lesion and Atrial Fibrillation—Insights from the Bulgarian Bifurcation Registry
Background and Objectives: Patients with atrial fibrillation and coronary artery disease represent a group with a greater risk of mortality. To evaluate patients with atrial fibrillation (AF) and a significant coronary bifurcation lesion and compare the clinical outcomes between the patients on anticoagulant treatment with Vitamin K antagonist (VKA) and those on direct anticoagulant (DOAC). Materials and Methods: This is a prospective study of patients with AF and stable coronary artery disease, who had evidence of a significant coronary bifurcation lesion. A log-rank test was used to assess the difference in mortality between patients taking VKA and those on DOAC. The primary endpoint was the incidence of all-cause and cardiovascular death at mid-term. Results: A total of 226 patients with AF and a significant bifurcation lesion were included. The mean age was 70.9 ± 9.2, and 70% were males. Of the patients, 123 (54.7%) were on VKA treatment, and 103 (45.3%) were taking DOAC. For a median follow-up time of 55 (39–96) months, overall mortality was 40%, whereas CV mortality was 31%. Both all-cause (28.2% versus 50.4%, p = 0.020) and CV death (12.7% versus 24.9%, p = 0.032) were significantly lower in patients taking DOAC versus those on VKA. In patients treated with PCI, CV mortality was significantly lower in patients taking DOAC (21.4% versus 40.5%, p = 0.032). VKA therapy was an independent predictor of cardiovascular death (HR 1.88; 95% CI 1.11–3.18; p = 0.01), together with chronic kidney disease (HR 1.81; 95% CI 1.13–2.92; p = 0.01). Conclusions: Treatment with DOAC in patients with atrial fibrillation and coronary bifurcation lesion was associated with significantly lower mortality independently of the treatment approach. VKA was an independent predictor of CV mortality.
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来源期刊
Medicina
Medicina Medicine-Medicine (all)
CiteScore
0.10
自引率
0.00%
发文量
66
审稿时长
24 weeks
期刊介绍: Publicada con el apoyo del Ministerio de Ciencia, Tecnología e Innovación Productiva. Medicina no tiene propósitos comerciales. El objeto de su creación ha sido propender al adelanto de la medicina argentina. Los beneficios que pudieran obtenerse serán aplicados exclusivamente a ese fin.
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