The impact of clinical phenotypes of coronary artery disease on outcomes in patients with atrial fibrillation: A post-hoc analysis of GLORIA-AF registry

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL European Journal of Clinical Investigation Pub Date : 2025-01-13 DOI:10.1111/eci.14378

Bi Huang, Yang Liu, Ho Man Lam, Hironori Ishiguchi, Tze-Fan Chao, Menno V. Huisman, Gregory Y. H. Lip, the GLORIA-AF Investigators

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Abstract

Background

Coronary artery disease (CAD) and atrial fibrillation (AF) often coexist, but the impact of clinical phenotypes of CAD on outcomes in AF patients in the non-vitamin K antagonist oral anticoagulant drugs (NOACs) era is less well understood.

Methods

This was a post-hoc of the GLORIA-AF registry, a global, multicenter, prospective AF registry study. Patients were divided into three groups: prior history of myocardial infarction (MI)/unstable angina group (Group 1); stable angina group (Group 2); and a control group without stable angina or history of MI/unstable angina. The primary endpoint was the composite of all-cause death or stroke, and the safety endpoint was major bleeding.

Results

A total of 24,827 patients were included in this analysis (median age was 71 (IQR, 64–78) years; 55% male) and 5394 (21.7%) had CAD. During a follow-up of 2 years, the incidence of the primary endpoint was 5.99 (95% CI, 5.33, 6.71) per 100 patient-years in Group 1, 4.04 (95% CI, 3.55, 4.70) per 100 patient-years in Group 2, and 2.79 (95% CI, 2.62, 2.96) per 100 patient-years in the control group (p < .001). Compared the control group, the adjusted hazard ratio of the primary composite endpoint in Groups 1 and 2 were 1.58 (95% CI, 1.37, 1.83, p < .001) and 1.22 (95% CI, 1.04, 1.43, p = .012), respectively. Among anticoagulated patients with AF and CAD, NOACs were associated with a reduced risk of the primary composite endpoint and major bleeding, compared with vitamin K antagonists (VKA).

Conclusions

CAD was prevalent in patients with AF, and clinical phenotypes of CAD influenced outcomes in patients with AF, with a history of MI/unstable angina being associated with a significantly increased risk of CV events, compared to stable angina. NOACs were superior to VKA in terms of the effectiveness and safety outcomes in patients with AF and concomitant CAD.

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冠状动脉疾病临床表型对房颤患者预后的影响：GLORIA-AF登记的事后分析

背景：冠状动脉疾病（CAD）和心房颤动（AF）常常同时存在，但在非维生素 K 拮抗剂口服抗凝药物（NOACs）时代，CAD 的临床表型对心房颤动患者预后的影响却不甚了解：这是一项全球性、多中心、前瞻性房颤登记研究 GLORIA-AF 登记的后期研究。患者分为三组：既往心肌梗死（MI）/不稳定心绞痛病史组（第1组）；稳定心绞痛组（第2组）；无稳定心绞痛或MI/不稳定心绞痛病史的对照组。主要终点是全因死亡或中风的复合终点，安全终点是大出血：共有 24827 名患者（中位年龄为 71（IQR，64-78）岁；55% 为男性）参与了此次分析，其中 5394 人（21.7%）患有 CAD。在 2 年的随访期间，主要终点的发病率分别为：第一组每 100 患者年 5.99（95% CI，5.33，6.71）例，第二组每 100 患者年 4.04（95% CI，3.55，4.70）例，对照组每 100 患者年 2.79（95% CI，2.62，2.96）例（P 结论：第一组和第二组的主要终点发病率分别为每 100 患者年 5.99（95% CI，5.33，6.71）例、4.04（95% CI，3.55，4.70）例和 2.79（95% CI，2.62，2.96）例：心房颤动患者中普遍存在CAD，而CAD的临床表型会影响心房颤动患者的预后，与稳定型心绞痛相比，有心肌梗死/不稳定型心绞痛病史的患者发生心血管事件的风险显著增加。就心房颤动并发心绞痛患者的有效性和安全性而言，NOACs优于VKA。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

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