Post-discharge antithrombotic management and clinical outcomes of patients with new-onset or pre-existing atrial fibrillation and acute coronary syndromes undergoing coronary stenting: Follow-up data of the MATADOR-PCI study

Introduction: Guidelines recommend dual-antiplatelet therapy (DAPT) for 12 months in patients with acute coronary syndromes (ACS). Information on patterns and duration of DAPT use after hospital discharge in ACS patients in Asia is sparse. Objective: We describe changes in real-life antithrombotic management patterns (AMPs) up to 2-y post discharge based on data from the EPICOR Asia study (NCT01361386). Methods: This observational study enrolled 12 922 hospital survivors post ACS from 218 hospitals in 8 countries/regions in Asia. Data were collected from symptom onset for the index event (ST-segment elevation myocardial infarction [STEMI] 51.2%, non-STEMI (NSTEMI) 19.9%, or unstable angina [UA] 28.9%), during hospitalization, at discharge and over 2 y follow-up. Results: Overall, 90.6% of patients were on DAPT at hospital discharge which declined to 79.6%, 71.8%, 53.7%, and 45.6% at 6, 12, 18, and 23 months post discharge (Fig). At discharge, most patients (87.6%) received aspirin + clopidogrel, with 79.5%, 71.8%, 53.6%, and 45.4% on this combination at 6, 12, 18, and 23 months. At discharge only 3.0% of patients received aspirin + prasugrel and 1.7% of patients received aspirin + cilostazol. Only 8.3% of patients were on single antiplatelet therapy (SAPT) at discharge with 12.2%, 15.6%, 28.1%, and 30.3% on SAPT at 6, 12, 18, and 23 months post discharge; aspirin being the most commonly used single agent. No notable differences were seen among index event groups. Of the patients on DAPT at discharge, STEMI 93.4%; NSTEMI 90.2%; UA 85.9%, comparable proportions across groups remained on DAPT at 23 months follow up; STEMI 51.0%; NSTEMI 51.9%; UA 47.6%. Conclusions: Most ACS patients remain on DAPT at 12 months and around half remain at 23 months post-discharge. Further study should assess between-country differences, the benefit/risk balance from prolonged DAPT, why DAPT is discontinued before 12 months, and impact on clinical outcomes.

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Genetic Variation of Migration Inhibitory Factor Gene rs2070766 Is Associated With Acute Coronary Syndromes in Chinese Population

Frontiers in Genetics ◽

10.3389/fgene.2021.750975 ◽

2022 ◽

Vol 12 ◽

Author(s):

Jin-Yu Zhang ◽

Qian Zhao ◽

Fen Liu ◽

De-Yang Li ◽

Li Men ◽

...

Keyword(s):

Genetic Variation ◽

Clinical Outcomes ◽

Migration Inhibitory Factor ◽

Chinese Population ◽

Acute Coronary Syndromes ◽

Multivariate Logistic Regression Analysis ◽

Inhibitory Factor ◽

Control Subjects ◽

Coronary Syndromes

Genetic variation of macrophage migration inhibitory factor (MIF) gene has been linked to coronary artery disease. We investigated an association between the polymorphism of MIF gene rs2070766 and acute coronary syndromes (ACS) and the predictive value of MIF gene variation in clinical outcomes. This study involved in 963 ACS patients and 932 control subjects from a Chinese population. All participants were genotyped for the single nucleotide polymorphism (SNP) of MIF gene rs2070766 using SNPscan™. A nomogram model using MIF genetic variation and clinical variables was established to predict risk of ACS. Major adverse cardiovascular events (MACE) were monitored during a follow-up period. The frequency of rs2070766 GG genotype was higher in ACS patients than in control subjects (6.2 vs 3.8%, p = 0.034). Multivariate logistic regression analysis revealed that individuals with mutant GG genotype had a 1.7-fold higher risk of ACS compared with individuals with CC or CG genotypes. Using MIF rs2070766 genotypes and clinical factors, we developed a nomogram model to predict risk of ACS. The nomogram model had a good discrimination with an area under the curve of 0.781 (95% CI: 0.759–0.804), concordance index of 0.784 (95% CI: 0.762–0.806) and well-fitted calibration. During the follow-up period of 25 months, Kaplan-Meier curves demonstrated that ACS patients carrying GG phenotype developed more MACE compared to CC or CG carriers (p < 0.05). GG genotype of MIF gene rs2070766 was associated with a higher risk of ACS in a Chinese population. The GG genotype carriers in ACS patients had worse clinical outcomes compared with those carrying CC or CG genotype. Together with rs2070766 genetic variant of MIF gene, we established a novel nomogram model that can provide individualized prediction for ACS.

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New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis

Revista Portuguesa de Cardiologia (English Edition) ◽

10.1016/j.repce.2013.10.046 ◽

2014 ◽

Vol 33 (5) ◽

pp. 281-287

Author(s):

Carlos Galvão Braga ◽

Vítor Ramos ◽

Catarina Vieira ◽

Juliana Martins ◽

Sílvia Ribeiro ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndromes ◽

Coronary Syndromes ◽

Onset Atrial Fibrillation ◽

New Onset

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Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes, heart failure and chronic kidney disease

World Journal of Cardiology ◽

10.4330/wjc.v7.i7.397 ◽

2015 ◽

Vol 7 (7) ◽

pp. 397 ◽

Cited By ~ 9

Author(s):

Nileshkumar J Patel

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Outcomes ◽

Acute Coronary Syndromes ◽

Prognostic Impact ◽

Coronary Syndromes

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New-onset or Pre-existing Atrial Fibrillation in Acute Coronary Syndromes: Two Distinct Phenomena With a Similar Prognosis

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2018.03.002 ◽

2019 ◽

Vol 72 (5) ◽

pp. 383-391 ◽

Cited By ~ 2

Author(s):

Luigi Biasco ◽

Dragana Radovanovic ◽

Marco Moccetti ◽

Hans Rickli ◽

Marco Roffi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndromes ◽

Coronary Syndromes ◽

New Onset

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Antithrombotic management and outcomes of patients with atrial fibrillation treated with NOACs early at the time of market introduction: Main results from the PREFER in AF Prolongation Registry

Internal and Emergency Medicine ◽

10.1007/s11739-020-02442-9 ◽

2020 ◽

Author(s):

Giulia Renda ◽

Ladislav Pecen ◽

Giuseppe Patti ◽

Fabrizio Ricci ◽

Dipak Kotecha ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Thromboembolic Risk ◽

Prevention Of Thromboembolic Events ◽

Life Threatening ◽

Coronary Syndromes ◽

One Year ◽

Antithrombotic Management ◽

European Registry

Abstract The management of patients with atrial fibrillation (AF) has rapidly changed with increasing use of non-vitamin K antagonist oral anticoagulants (NOACs) and changes in the use of rhythm control therapy. The prevention of thromboembolic events European Registry in Atrial Fibrillation Prolongation Registry (PREFER Prolongation) enrolled consecutive patients with AF on NOACs between 2014 and 2016 in a multicentre, prospective, observational study with one-year follow-up, focusing on the time of introduction of NOACs. Overall, 3783 patients were enrolled, with follow-up information available in 3223 (85%). Mean age was 72.2 ± 9.4 years, 40% were women, mean CHA2DS2VASc score was 3.4 ± 1.6, and 2587 (88.6%) had a CHA2DS2VASc score ≥ 2. Rivaroxaban was used in half of patients, and dabigatran and apixaban were used in about a quarter of patients each; edoxaban was not available for use in Europe at the time. Major cardiovascular event rate was low: serious events occurred in 74 patients (84 events, 2%), including 24 strokes (1%), 62 major bleeds (2%), of which 30 were life-threatening (1%) and 3 intracranial (0.1%), and 28 acute coronary syndromes (1%). Mortality was 2%. Antiarrhythmic drugs were used in about 50% of patients, catheter ablation in 5%. Adverse events were low in this contemporary European cohort of unselected AF patients treated with NOACs already at the time of their first introduction, despite high thromboembolic risk.

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