Vol. 25 No. 4 (2021)
Endovascular Surgery

Impact of atrial fibrillation on long-term outcomes in patients with coronary artery bifurcation lesions undergoing percutaneous coronary intervention

D.A. Khelimskii
Meshalkin National Medical Research Center, Novosibirsk
Bio
O.V. Krestyaninov
Meshalkin National Medical Research Center, Novosibirsk
A.G. Badoian
Meshalkin National Medical Research Center, Novosibirsk
A.A. Baranov
Meshalkin National Medical Research Center, Novosibirsk
R.B. Utegenov
Meshalkin National Medical Research Center, Novosibirsk
I.S. Bessonov
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
S.S. Sapozhnikov
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk

Published 2021-12-28

Keywords

  • antiplatelet therapy,
  • atrial fibrillation,
  • coronary artery bifurcation,
  • percutaneous coronary intervention

How to Cite

Khelimskii, D., Krestyaninov, O., Badoian, A., Baranov, A., Utegenov, R., Bessonov, I., & Sapozhnikov, S. (2021). Impact of atrial fibrillation on long-term outcomes in patients with coronary artery bifurcation lesions undergoing percutaneous coronary intervention. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 25(4), 85–96. https://doi.org/10.21688/1681-3472-2021-4-85-96

Abstract

Background. Atrial fibrillation is one of the most common types of cardiac arrhythmias. The frequent combination of atrial fibrillation and coronary artery disease in clinical practice can be attributed to common risk factors and relationships among pathogenetic mechanisms.
Aim. This study aims to evaluate the impact of atrial fibrillation on immediate and long-term clinical outcomes in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.
Methods. This study included 709 patients who underwent percutaneous coronary intervention for coronary bifurcation lesions. All patients were divided into two groups: those with and without atrial fibrillation.
Results. This multicentre registry showed that the incidence of atrial fibrillation was 11.7%. Compared to patients without a history of atrial fibrillation, those that did were older (66.8 ± 8.5 vs. 62.9 ± 9.0 years, p = 0.0002) and more often had cerebrovascular (22.9% vs. 10.4%, p = 0.003) and peripheral artery disease (18.1% vs. 7.2%, p = 0.002). The overall incidence of major adverse cardiovascular events at the hospital stage was 1.8%. The average follow-up duration was 476 ± 94 days. No difference in long-term major adverse cardiovascular events (15.0% vs. 13.1%, p = 0.6) was observed between patients with and without atrial fibrillation. Patients with atrial fibrillation were more likely to have adverse events, such as bleeding (13.8% vs. 9.3%, p = 0.22), stroke (2.5% vs. 1.0%, p = 0.23) and myocardial infarction (7.6% vs. 5.0%, p = 0.28), although differences between the groups were insignificant.
Conclusion. Atrial fibrillation was not associated with mortality and major adverse cardiovascular events in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.

ClinicalTrials.gov Identifier: NCT03450577

Received 4 August 2021. Revised 27 September 2021. Accepted 28 September 2021.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Contribution of the authors
Conception and study design: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov
Data collection and analysis: D.A. Khelimskii, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov
Statistical analysis: D.A. Khelimskii, A.G. Badoian, I.S. Bessonov
Drafting the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov
Critical revision of the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov
Final approval of the version to be published: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov

References

  1. Kannel W.B., Wolf P.A., Benjamin E.J., Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82(8A):2N-9N. PMID: 9809895. https://doi.org/10.1016/s0002-9149(98)00583-9
  2. Go A.S., Hylek E.M., Phillips K.A., Chang Y., Henault L.E., Selby J.V., Singer D.E. 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. 2001;285(18):2370-2375. PMID: 11343485. https://doi.org/10.1001/jama.285.18.2370
  3. Sutton N.R., Seth M., Ruwende C., Gurm H.S. Outcomes of patients with atrial fibrillation undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2016;68(9):895-904. PMID: 27561762. https://doi.org/10.1016/j.jacc.2016.05.085
  4. Chen X., Zhang D., Yin D., Li J., Zhao Zh., Wang H., Yang Y., Xu B., Dou K. Can ‘true bifurcation lesion’ actually be regarded as an independent risk factor of acute side branch occlusion after main vessel stenting?: A retrospective analysis of 1,200 consecutive bifurcation lesions in a single center. Catheter Cardiovasc Interv. 2016:87(Suppl 1):554-563. PMID: 26863899. https://doi.org/10.1002/ccd.26403
  5. Burzotta F., Lassen J.F., Lefèvre T., Banning A.P., Chatzizisis Y.S., Johnson T.W., Ferenc M., Rathore S., Albiero R., Pan M., Darremont O., Hildick-Smith D., Chieffo A., Zimarino M., Louvard Y., Stankovic G. Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club. EuroIntervention. 2021;16(16):1307-1317. PMID: 33074152. https://doi.org/10.4244/EIJ-D-20-00169
  6. Tan S., Ramzy J., Burgess S., Zaman S. Percutaneous coronary intervention for coronary bifurcation lesions: latest evidence. Curr Treat Options Cardiovasc Med. 2020;22(2):6. PMID: 32034505. https://doi.org/10.1007/s11936-020-0806-4
  7. Manaktala R., Kluger J. Role of antiplatelet therapy in stroke prevention in patients with atrial fibrillation. J Am Osteopath Assoc. 2017;117(12):761-771. PMID: 29181519. https://doi.org/10.7556/jaoa.2017.148
  8. Lip G.Y.H., Laroche C., Dan G.-A., Santini M., Kalarus Z., Rasmussen L.H., Ioachim P.M., Tica O., Boriani G., Cimaglia P., Diemberger I., Hellum C.F., Mortensen B., Maggioni A.P. 'Real-world' antithrombotic treatment in atrial fibrillation: The EORP-AF pilot survey. Am J Med. 2014;127(6):519-529.e1. PMID: 24486284. https://doi.org/10.1016/j.amjmed.2013.12.022
  9. Thygesen K., Alpert J.S., Jaffe A.S., Chaitman B.R., Bax J.J., Morrow D.A., White H.D., ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-269. https://doi.org/10.1093/eurheartj/ehy462
  10. Cutlip D.E., Windecker S., Mehran R., Boam A., Cohen D.J., van Es G.-A., Steg P.G., Morel M.-A., Mauri L., Vranckx P., McFadden E., Lansky A., Hamon M., Krucoff M.W., Serruys P.W.; Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115(17):2344-2351. PMID: 17470709. https://doi.org/10.1161/CIRCULATIONAHA.106.685313
  11. Mehran R., Rao S.V., Bhatt D.L., Gibson C.M., Caixeta A., Eikelboom J., Kaul S., Wiviott S.D., Menon V., Nikolsky E., Serebruany V., Valgimigli M., Vranckx P., Taggart D., Sabik J.F., Cutlip D.E., Krucoff M.W., Ohman E.M., Steg P.G., White H. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736-2747. PMID: 21670242. https://doi.org/10.1161/CIRCULATIONAHA.110.009449
  12. O'Neal W.T., Soliman E.Z., Howard G., Howard V.J., Safford M.M., Cushman M., Zakai N.A. Inflammation and hemostasis in atrial fibrillation and coronary heart disease: The REasons for Geographic And Racial Differences in Stroke study. Atherosclerosis. 2015;243(1):192-197. PMID: 26398291; PMCID: PMC4634936. https://doi.org/10.1016/j.atherosclerosis.2015.09.009
  13. Sandoval Y., Smith S.W., Thordsen S.E., Apple F.S. Supply / demand type 2 myocardial infarction: should we be paying more attention? J Am Coll Cardiol. 2014;63(20):2079-2087. PMID: 24632278. https://doi.org/10.1016/j.jacc.2014.02.541
  14. Guo Y., Lip G.Y.H., Apostolakis S. Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012;60(22):2263-2270. PMID: 23194937. https://doi.org/10.1016/j.jacc.2012.04.063
  15. Al-Khatib S.M., Pieper K.S., Lee K.L., Mahaffey K.W., Hochman J.S., Pepine C.J., Kopecky S.L., Akkerhuis M., Stepinska J., Simoons M.L., Topol E.J., Califf R.M., Harrington R.A. Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: results from the PURSUIT trial. Am J Cardiol. 2001;88(1):A7, 76-79. PMID: 11423065. https://doi.org/10.1016/s0002-9149(01)01593-4
  16. Bramlage P., Cuneo A., Zeymer U., Hochadel M., Richardt G., Silber S., Senges J., Nienaber C.A., Tebbe U., Kuck K.-H. Prognosis of patients with atrial fibrillation undergoing percutaneous coronary intervention receiving drug eluting stents. Clin Res Cardiol. 2013;102(4):289-297. PMID: 23291664. https://doi.org/10.1007/s00392-012-0533-2
  17. Lamberts M., Olesen J.B., Ruwald M.H., Hansen C.M., Karasoy D., Kristensen S.L., Køber L., Torp-Pedersen C., Gislason G.H., Hansen M.L. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention: a nationwide cohort study. Circulation. 2012;126(10):1185-1193. PMID: 22869839. https://doi.org/10.1161/CIRCULATIONAHA.112.114967
  18. Lamberts M., Gislason G.H., Lip G.Y.H., Lassen J.F., Olesen J.B., Mikkelsen A.P., Sørensen R., Køber L., Torp-Pedersen C., Hansen M.L. Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant: a nationwide cohort study. Circulation. 2014;129(15):1577-1585. PMID: 24470482. https://doi.org/10.1161/CIRCULATIONAHA.113.004834
  19. Cannon C.P., Bhatt D.L., Oldgren J., Lip G.Y.H., Ellis S.G., Kimura T., Maeng M., Merkely B., Zeymer U., Gropper S., Nordaby M., Kleine E., Harper R., Manassie J., Januzzi J.L., Ten Berg J.M., Steg P.G., Hohnloser S.H., RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377(16):1513-1524. PMID: 28844193. https://doi.org/10.1056/NEJMoa1708454
  20. Gibson C.M., Mehran R., Bode C., Halperin J., Verheugt F.W., Wildgoose P., Birmingham M., Ianus J., Burton P., van Eickels M., Korjian S., Daaboul Y., Lip G.Y.H., Cohen M., Husted S., Peterson E.D., Fox K.A. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016;375(25):2423-2434. PMID: 27959713. https://doi.org/10.1056/NEJMoa1611594
  21. Han S., Park G.-M., Kim Y.-G., Hwang K.W., Roh J.-H., Won K.-B., Ann S.H., Kim S.-J., Lee S.-G. Effect of atrial fibrillation in Asian patients undergoing percutaneous coronary intervention with drug-eluting stents for stable coronary artery disease: Results from a Korean nationwide study. Medicine (Baltimore). 2018;97(48):e13488. PMID: 30508978; PMCID: PMC6283148. https://doi.org/10.1097/MD.0000000000013488
  22. Wang T.Y., Robinson L.A., Ou F.-Sh., Roe M.T., Ohman E.M., Gibler W.B., Smith S.C. Jr, Peterson E.D., Becker R.C. Discharge antithrombotic strategies among patients with acute coronary syndrome previously on warfarin anticoagulation: physician practice in the CRUSADE registry. Am Heart J. 2008;155(2):361-368. PMID: 18215609. https://doi.org/10.1016/j.ahj.2007.09.003
  23. Odutayo A., Wong C.X., Hsiao A.J., Hopewell S., Altman D.G., Emdin C.A. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016;354:i4482. PMID: 27599725. https://doi.org/10.1136/bmj.i4482
  24. Pilgrim T., Kalesan B., Zanchin T., Pulver C., Jung S., Mattle H., Carrel T., Moschovitis A., Stortecky S., Wenaweser P., Stefanini G.G., Räber L., Meier B., Jüni P., Windecker S. Impact of atrial fibrillation on clinical outcomes among patients with coronary artery disease undergoing revascularisation with drug-eluting stents. EuroIntervention. 2013;8(9):1061-1071. PMID: 23339812. https://doi.org/10.4244/EIJV8I9A163