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Influence of vitamin K antagonists and direct oral anticoagulation on coronary artery disease: A CTA analysis.

Abstract：

OBJECTIVE:Vitamin K antagonists (VKA) are associated with increased vascular calcification which may lead to an elevated cardiovascular risk. If the direct anticoagulants (DOACs) have similar negative vascular effects is unknown. We evaluated the influence of different anticoagulation strategies on coronary artery disease (CAD) using coronary computed tomography angiography (CTA). METHODS:Overall 702 consecutive patients with non-valvular atrial fibrillation (AF) who underwent CTA for AF ablation planning were enrolled and stratified according to their anticoagulation into VKA, DOAC (all agents) and a control group without oral anticoagulation. Patients were propensity score matched 1:1:1, significant structural heart disease and comorbidities were excluded. CT images were evaluated for plaque burden (calcium score, segment involvement score (SIS) and non-calcified SIS, stenosis grading) and plaque morphology (high risk plaque features: low attenuation, positive remodeling, napkin-ring sign, spotty calcification). RESULTS:Final analysis included 303 patients (101 patients each group) and showed increased overall plaque burden in patients using VKA compared to DOAC users and the control group (mean affected segments 2.58 vs 1.58 vs 2.100, p = 0.008), and a higher prevalence of high-risk plaque (HRP) features (42.6% vs 13.9% vs 26.7%, p < 0.0001). Patients treated with DOACs did not differ in conventional CT findings from the control group and showed an even lower prevalence of selected HRP features compared to the control group: low-attenuation plaques (4.0% vs. 14.4%, p = 0.014) and napkin-ring sign (0 vs. 5.0%, p = 0.029). CONCLUSION:Vitamin K antagonists are associated with a higher plaque burden and increased high-risk plaque features, whereas DOACs may yield a benefit in cardiovascular atherosclerosis.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Plank F,Beyer C,Friedrich G,Stühlinger M,Hintringer F,Dichtl W,Wildauer M,Feuchtner G

doi

10.1016/j.ijcard.2018.03.019

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

11-15

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(17)37362-X

journal_volume

260

pub_type

杂志文章

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