• Daisuke Fukamachi, Yasuo Okumura, Katsuaki Yokoyama, Naoya Matsumoto, Eizo Tachibana, Keiichiro Kuronuma, Koji Oiwa, Michiaki Matsumoto, Toshihiko Nishida, Toshiaki Kojima, Shoji Hanada, Kazumiki Nomoto, Kazumasa Sonoda, Ken Arima, Rikitake Kogawa, Fumiyuki Takahashi, Tomobumi Kotani, Kimie Ohkubo, Seiji Fukushima, Satoru Itou, Kunio Kondo, Masaaki Chiku, Yasumi Ohno, Motoyuki Onikura, Atsushi Hirayama, and SAKURA AF Registry Investigators.
• Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan.
• Curr Med Res Opin. 2019 Dec 1; 35 (12): 2053-2062.

AbstractBackground: Although atrial fibrillation (AF) and coronary artery disease (CAD) are increasing in prevalence in Japan, real-world data regarding clinical outcomes in Japanese AF patients with CAD are limited.Methods: The SAKURA AF Registry is a prospective multi-center registry created to investigate outcomes of oral anticoagulant (OAC) use in Japanese AF patients. A study was conducted involving 3237 enrollees from 63 Tokyo-area institutions who were followed up for a median of 39.3 months. Clinical adverse events were compared between the patients accompanied with (n = 312) and without CAD (n = 2925).Results: The incidence of cardiovascular events and all-cause mortality rates were significantly higher among patients with CAD than among those without CAD (5.98 vs 2.52 events per 100 patient-years, respectively, p < 0.001; 3.27 vs 1.94 deaths per 100 patient-years, respectively, p = 0.012), but there was no difference in strokes/transient ischemic attacks or systemic embolisms (1.70 vs 1.34). After a multivariate adjustment, CAD remained a risk factor for cardiovascular events (hazard ratio [HR] = 1.57, 95% confidence interval [CI] = 1.08-2.25, p = 0.018). Among CAD patients, the propensity score-adjusted risk for major bleeding was significantly decreased among direct oral anticoagulant (DOAC) users in comparison to that among warfarin users (HR = 0.29, 95% CI = 0.07-0.94, p = 0.04), but other adverse clinical events did not differ significantly between these two groups.Conclusions: CAD did not appear to be a major determinant of strokes/TIAs, major bleeding, or all-cause mortality, but appeared to increase the risk of cardiovascular events in Japanese AF patients. The risk of major bleeding in CAD patients appeared to decrease when a DOAC rather than warfarin was administered. The data suggested that patients with AF and concomitant CAD require careful management and follow-up to reduce cardiovascular risks, and DOACs may be a better choice over warfarin when considering the risk of major bleeding.

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