Fabian Plank1, Christoph Beyer2, Guy Friedrich3, Markus Stühlinger4, Florian Hintringer5, Wolfgang Dichtl6, Matthias Wildauer7, Gudrun Feuchtner8. 1. Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Austria. Electronic address: fabian.plank@i-med.ac.at. 2. Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Austria. Electronic address: christoph.beyer@student.i-med.ac.at. 3. Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Austria. Electronic address: guy.friedrich@tirol-kliniken.at. 4. Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Austria. Electronic address: markus.stuehlinger@tirol-kliniken.at. 5. Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Austria. Electronic address: florian.hintringer@tirol-kliniken.at. 6. Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Austria. Electronic address: wolfgang.dichtl@tirol-kliniken.at. 7. Innsbruck Medical University, Department of Radiology, Austria. Electronic address: matthias.wildauer@tirol-kliniken.at. 8. Innsbruck Medical University, Department of Radiology, Austria. Electronic address: gudrun.feuchtner@tirol-kliniken.at.
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.
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, spottycalcification). 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.
Authors: A J W M de Veer; N Bennaghmouch; W L Bor; J P R Herrman; M Vrolix; M Meuwissen; T Vandendriessche; T Adriaenssens; B de Bruyne; M Magro; W J M Dewilde; J M Ten Berg Journal: Neth Heart J Date: 2022-03-01 Impact factor: 2.380