Clinical utility of the BIWACO score for patients with atrial fibrillation after percutaneous coronary intervention

Abstract

No predictive clinical risk scores for net adverse clinical events (NACE) have been developed for patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). We evaluated NACE to develop clinically applicable risk-stratification scores in the Bleeding and thrombotic risk evaluation In patients With Atrial fibrillation under COronary intervention (BIWACO) study, a multicenter survey which has enrolled a total of 7837 patients. We also investigated the current status and time trends for the use of antithrombotic drugs. A total of 188 AF patients who had received PCI were examined. At discharge, 65% of patients were prescribed a triple therapy (TT), 6% were prescribed a dual therapy, the remaining 29% of patients received dual-antiplatelet therapy. After 4 years, the fraction of patients continuing TT decreased by 15%, whereas oral anticoagulant alone was only 2% of patients. NACE developed in 20% of patients, resulting in death in 5% of the patients, and the remaining 13% experienced bleeding events. We developed risk scores for NACE comprising the five strongest predictive items, which we designated BIWACO scores. The area under the curve was 0.774 for NACE. Our study explored the differences in treatment practices and guideline recommendations for antithrombotic therapy. We concluded that our BIWACO score is useful for predicting clinical outcomes in AF-patients after PCI.

Keywords: Anticoagulants; Atrial fibrillation; Percutaneous coronary intervention; Risk score.

Fig. 1

Percentage of Incidence. NACE net adverse clinical events

Fig. 2

The predictive risk scores (BIWACO scores) for NACE. NACE net adverse clinical events

Fig. 3

Distribution of the BIWACO score. a Patient number according to the each BIWACO score (point 0–5). b Percentage of event rates according to the each BIWACO score

Fig. 4

Kaplan–Meier estimates of patients free of NACE among patients stratified by high (red line)-vs-low (blue line) BIWACO risk scores. NACE net adverse clinical events

Fig. 5

Comparison of Kaplan–Meier curves and AUC for predicting NACE among patients stratified according to BIWACO, PRECISE-DAPT, PARIS-MB, ORBIT, or HAS-BLED scores. AUC area under the curve; NACE net adverse clinical events

Fig. 6

Antithrombotic drug prescriptions and switching regimens. a Trends in prescriptions of antithrombotic regimens from baseline to the late phase. The figure shows the proportion of patients receiving single antiplatelet therapy (SPAT), oral anticoagulant alone (OAC), dual-therapy (OAC plus antiplatelet therapy) (DT), dual antiplatelet therapy (DAPT), or triple therapy (TT). b Timing of anti-thrombotic regimen switching