高栓塞风险心房颤动患者PCI术后抗凝治疗对长期预后的影响

Effect of anticoagulants on the Long-Term prognosis of patients with AF-PCI and high risk of thromboembolism after percutaneous coronary intervention

目的评估高栓塞风险心房颤动患者经皮冠状动脉介入(AF-PCI)术后口服抗凝治疗对不良预后的影响。方法分析2013年1月~2019年1月北京同仁医院住院治疗的高栓塞风险AF-PCI患者108例,按出院时是否接受口服抗凝药物(OACs)分为抗凝组(n=45)和未抗凝组(n=63)。随访并比较两组出院后系统性血栓栓塞事件、主要不良心脑血管事件(MACCE)及出血情况,评估出院时OACs治疗对长期不良预后的影响。结果随访期间共发生15例血栓栓塞事件,抗凝组3例(7%),低于未抗凝组12例(19%),P<0.05;MACCE事件共26例,抗凝组6例(13%),低于未抗凝组20例(44%),P<0.05;出血事件分别为抗凝组11例(24%)和未抗凝组11例(18%),差异无统计学意义。结论高栓塞风险AF-PCI患者术后OACs治疗不足;OACs治疗可有效降低AF-PCI患者系统性血栓栓塞和MACCE的发生,且未明显增加出血风险。

AIM To evaluate the effect of oral anticoagulants(OACs)on the long-term adverse prognosis in patients with atrial fibrillation and coronary artery disease at high risk of thrombosis after percutaneous coronary intervention(AF-PCI).METHODS A retrospective study was performed on 108 patients with AF-PCI at high risk of thrombo hospitalized in Beijing Tonren hospital from January2013 to January 2019.All patients were divided into with OACs group(n=45)and in the other group(n=63).We followed up and compared two groups of systemic thromboembolic events,major adverse cardiovascular and cerebrovasluar events(MACCE)including systemic thromboembolism,cardiovascular death,recurrence of acute myocardial infarction,treatment for stent thrombosis and revascularization and serious bleeding events to evaluate the effect of OACs on long-term adverse prognosis in patients with AF-PCI at high risk of thrombo.RESULTS In total,there were 15 systemic thromboembolism events that happened during the follow-up period.Of the total cases,three cases(7%)of thromboembolism events in with OACs groups was lesser than 12 cases(19%)in the other group.The statistical difference between them was P<0.05.Twenty-six cases of MACCE were observed,6 cases(13%)and 20 cases(44%),respectively,showed a statistically significant difference P<0.05.There were11 cases(24%)of bleeding events in OACs groups and 11 cases(18%)in the other group,both of which were minor bleeding events,without significant difference.CONCLUSION The use of OACs is obviously insufficient in patients with AF-PCI and high risk of thromboembolism,however,OACs effectively reduce the risk of without increasing bleeding.