Abstract 16360: Is Oral Anticoagulation Needed in Patients with Coronary Artery Disease, Atrial Fibrillation and CHADS2 Score=0 or 1? A Real World Community Based Cohort Study
Thromboprophylaxis for patients with coronary artery disease and atrial fibrillation (AF) may often be antiplatelet therapy when there is a low or intermediate risk of stroke (CHADS2 score=0 or 1), particularly when patients experience an acute coronary syndrome or undergo intracoronary stent placement. Some physicians may be reluctant to prescribe oral anticoagulation (OAC) in these patients and several recent guidelines propose slightly different management in such settings. Our goal was to evaluate whether treatment with an OAC is appreciably beneficial in these AF patients in a ‘real world’ community cohort study.
Methods: All patients with AF seen between 2000 and 2010 were identified in a database and followed up for mortality, stroke and bleeding events. The CHADS2 score was calculated for each patient as initially described, based on 2 points for a history of stroke or TIA, and 1 point each for age ≥75, hypertension, diabetes, and cardiac failure.
Results: Among 8962 patients with AF seen between 2000-2010, 833 (9%) had coronary artery disease and CHADS2 score=0 or 1. In these patients (age 70±10 years), antiplatelet therapy was prescribed on an individual basis for 499 patients (60%) and OAC for 440 (53%). During a follow-up of 962±1093 days, 57 strokes/thromboembolic events and 90 deaths were recorded in 125/833 patients. Major adverse cardiac events (MACE; i.e. death, acute myocardial infarction, target lesion revascularization) were recorded in 186 patients. In multivariate analysis, after adjustment for 20 possible confounding factors (including history of acute coronary syndrome, stent placement, use of antiplatelet therapy, HASBLED bleeding risk score and each consistent or moderate risk factor for stroke), prescription of OAC was associated with a better prognosis for the combined risk of death or stroke (relative risk=0.60, 95% CI 0.40-0.89, p=0.01) and for the risk of MACE (relative risk=0.68, 95% CI 0.49-0.94, p=0.02).
Conclusions: Prescription of an anticoagulant is independently associated with a decreased risk of death or stroke and a decreased risk of MACE among patients with coronary artery disease, AF and a CHADS2 score =0 or 1.
- © 2012 by American Heart Association, Inc.