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￭♣ Sat-125 ￭
Impact of diabetes mellitus in patients with coronary artery disease:
1동아대병원, 2가천대학교, 3울산대병원
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김나영
1, 조용락
1, 김영대
1, 한승봉
2, 박경민
3Background/Aims: Despite a clear improvement in the treatment and survival rate in patients with coronary artery disease (CAD) during recent decades, diabetes mellitus (DM) is still known as a risk factor for adverse clinical outcomes in these patients. However, there are limited data to evaluate the clinical im- plications of DM in the contemporary practice Methods: Based on the national health insurance claims data in South Korea, patients aged 18 years or older, who had undergone percutaneous coronary intervention for the diagnosis of CAD between 2011 and 2015, were analyzed. According to the presence of DM, patients were classified into DM (n=27,086) and non-DM (n=54,029) groups. The primary endpoint, defined as all-cause death, was compared between the two groups using a propensity-score matching analysis Results: The study population was categorized as patients with angina (n=49,228) or acute myocardial infarction (AMI, n=31,887). After propensity-score matching, there were 8,157 pairs in patients with angina and 4,266 pairs in those with AMI, respectively.
In angina group, during the follow-up period (median, 2.1 years; interquartile range, 1.1–3.2), the incidence for the primary endpoint was significantly higher in the patients with DM (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI]: 1.16-1.47; p<0.001) compared with those without. In AMI group, the occurrence of primary endpoint was also significantly higher in diabetic patients (aHR, 1.35; 95% CI: 1.19-1.53; p<0.001) compared with non-diabetic patients. Conclusions: In Korean patients with CAD, the presence of DM was associated with poorer clinical outcomes
￭♣ Sat-126 ￭
Natural course, implication of anticoagulation in patients with postoperative atrial fibrillation
울산의대 서울아산병원
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현준호, 조민수, 남기병, 김유나, 김준, 최기준, 김유호
Background/Aims: Little data is available on post-operative atrial fibrillation (POAF) after non-cardiac surgery. We sought to evaluate the natural course of POAF and clinical implication of anticoagulation in patients without prior history of AF. Methods: Between 2009 to 2016, perioperative AF was diagnosed in 2,071 patients (0.64%), 449 (0.14%) new-onset POAF was identified. After exclusion of persistent POAF (n=5), the clinical data of 444 patients (mean 67 years, 64% male) with new-onset POAF who were discharged in a sinus rhythm were evaluated. The main outcomes of current study were recurrent AF, thromboembolic event, and clinically relevant bleeding during follow-up. Results: Recurrent AF was found in only 60 (13.5%) patients during a 2 year fol- low-up period. Hypertension (HR 1.89, 95% CI 1.08-3.30, p=0.026), vascular disease (HR 2.16, 95% CI 1.19-3.93, p=0.012), moderate-severe left atrial en- largement (HR 2.42, 95% CI 1.34-4.36, p=0.003) were independent predictors of recurrence. These patients with recurrent AF were at higher risk of throm- boembolic event compared to those without (15.0% vs. 4.0%, p=0.026). In these patients with recurrent AF, the rate of ischemic stroke was lower in those us- ing anticoagulation than those without (18% vs. 4%), although statistical significance was not reached. When the overall patients were divided into two groups according to a anticoagulation prescription on discharge, a total of 99 patients (22.3%) received standard anticoagulation. The rate of death (44.7% vs. 41.7%, p=0.456) and thromboembolic event (4.3% vs. 5.7%, p=0.612) were not significantly different between those with and without anticoagulation during fol- low-up. However, the rate of clinically-relevant bleeding was significantly higher in those patients who received anticoagulants (33.4% vs. 12.6%, p<0.001).
This risk of bleeding was significant even after multivariable adjustment (HR 3.58, 95% CI 2.00-6.40, p<0.001). Conclusions: Anticoagulation did not im- pact on thromboembolic events for 2 years. Deferred rather than routine, use of standard anticoagulation which is restricted to those with high thromboembolic risk such as recurrent AF with hypertension, vascular disease, enlarged LA would be beneficial.
