AF linked to increased post-PCI complications
medwireNews: A history of atrial fibrillation (AF) is associated with an increased risk of in-hospital bleeding, heart failure, cardiogenic shock and mortality among patients undergoing percutaneous coronary intervention (PCI), US study data show.
The findings, based on 113,283 consecutive PCI cases performed at 47 hospitals between 2011 and 2014, “highlight the importance of AF as an independent risk factor for poor clinical outcomes after PCI”, say the study’s authors.
Among the PCI cases, 12.0% (n=13,912) had a history of AF, a rate that varied by institution from 2.5% to 18.4% and that underlines “how commonly this scenario occurs in contemporary clinical practice”, Hitinder Gurm (University of Michigan, Ann Arbor) and co-authors remark.
At baseline, patients with a history of AF were more likely than those without to be older and to have prior congestive heart failure and coronary artery disease, cardiomyopathy, cerebrovascular disease, hypertension, chronic lung disease, diabetes and chronic kidney disease.
After propensity matching, patients with a history of AF were significantly more likely than those without to receive a bare-metal stent (27.2 vs 18.1%) or angioplasty alone (11.9 vs 11.1%), and less likely to receive a drug-eluting stent (61.7 vs 71.7%). Patients with AF were also more likely to have had radial arterial access (21.1 vs 18.9%).
In-hospital rates of heart failure (4.3 vs 3.3%), cardiogenic shock (2.8 vs 2.3%) and mortality (3.0 vs 2.4%) were all significantly higher in the patients with a history of AF, with respective odds ratios of 1.33, 1.26 and 1.41.
And patients with a history of AF also had significantly higher rates of post-procedural bleeding within 72 hours (3.7 vs 2.8%) and blood transfusions (5.2 vs 4.6%).
But the researchers point out that more frequent use of heparin alone during the procedure and clopidogrel post-procedure, and less frequent use of intra-procedural eptifibatide and post-procedural prasugrel and ticagrelor suggests that clinicians were “attempting to mitigate a presumed elevated risk of bleeding in this population”.
By contrast, there were no significant differences in the incidence of post-procedural stroke, acute kidney injury, dialysis initiation or vascular complications in the matched cohorts.
Writing in the Journal of the American College of Cardiology, the researchers conclude: “Prospective clinical studies are needed to evaluate the impact of prophylactic therapies on post-procedural morbidity and mortality in patients with a history of AF undergoing PCI.”
By Laura Cowen
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