Current Status of Percutaneous Coronary Intervention in Patients with Atrial Fibrillation: The Fushimi AF Registry

Background: Antithrombotic therapies that are optimal for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) have been studied but remain uncertain. We often encounter difficulties in choosing an appropriate antithrombotic therapy with antiplatelet agents after PCI in AF patients treated with oral anticoagulant due to a high CHADS score. Since there are no data on the incidences of PCI procedures in AF patients, we evaluated those incidences as well as the association between PCI and the CHADS score using data from the Fushimi AF Registry.

Methods: The Fushimi AF Registry is a community-based prospective cohort study of AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available for 4325 patients, and the median follow-up was 3.6 (interquartile range: 1.9-5.9) years.

Results: There were 143 PCI procedures performed in 122 patients during follow-up, and 28 (20%) were emergent ones. The crude incidence of PCI procedures was 9.36 per 1000 person-years. At 1 and 3 years, the cumulative incidences of PCI were 46 (1.1%) and 85 (2.4%), respectively. As for 4 age groups: <65 (n = 765), 65-75 (n = 1359), 75-85 (n = 1586), and 85≤ years (n = 615), the rates of PCI were 0.4%, 1.4%, 1.4%, and 0.6% at 1 year, and were 1.4%, 2.7%, 2.8%, and 1.6% at 3 years, respectively. The incidence of PCI procedures in patients with a CHADS score ≥2 (n = 2651, 61.3%) was higher than that in patients with a CHADS score ≤1 (n = 1674, 38.7%). Among the factors making up the CHADS score, only diabetes mellitus was associated with PCI procedures in patients with AF (hazard ratio, 1.95; 95% confidence interval, 1.34-2.83; p = 0.0005).

Conclusions: About 1 in 100 AF patients underwent PCI annually, and patients with a CHADS score ≥2 were associated with higher incidences of PCI procedures.