No abstract

Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (aspirin) and a P2Y 12 antagonist is recommended for patients undergoing percutaneous coronary intervention (PCI), mainly to prevent stent thrombosis, and for acute coronary syndrome (ACS) patients, mostly to prevent recurrent events. 1 For patients with atrial fibrillation (AF), oral anticoagulation therapy is required to decrease the risk of stroke or systemic embolism. 2 In daily practice, patients with concomitant coronary artery disease and AF are frequently encountered, since 30% of patients with AF also have coronary artery disease, 10%-15% of patients with AF receive PCI, and up to 15% of patients with stable coronary artery disease have concomitant AF. 3 This raises concerns regarding the cotreatment with various antithrombotic and antiplatelet drugs, given that a high risk of bleeding is associated with DAPT in combination with oral anticoagulation therapy (triple antithrombotic therapy [TAT]), especially in patients with AF who receive PCI or who have ACS. 4 Several systematic reviews with meta-analysis based on evidence from randomized controlled trials (RCTs) [5][6][7][8] have been conducted to address this issue. 3,[9][10][11] All these systematic reviews have led to similar conclusions: that omitting aspirin resulted in fewer major bleeds, while preserving the efficacy of therapy, compared with TAT (combining a vitamin K antagonist [VKA] or novel oral anticoagulant [NOAC] with DAPT). Moreover, the use of NOAC + P2Y 12 inhibitor was recommended as the preferred regimen after PCI for these high-risk patients with AF. 9 Although the summarized bleeding risk of these meta-analyses

IntroductionPhosphate has been linked to higher cardiovascular (CV) risk. However, whether phosphate is associated with poor outcomes for patients with coronary artery disease (CAD) after percutaneous coronary interventions (PCIs) remained undetermined. Methods 2,894 CAD patients (2,220 male, aged 71.6 ± 12.2), who received PCI at TVGH from 2006 to 2015, with phosphate measurement, were enrolled. The primary outcome was the composite of major adverse CV events [MACE, comprising of CV death, nonfatal MI, and nonfatal stroke] and heart failure hospitalization(HHF). The key secondary outcome was MACE. ResultsThere was a J-curve association between phosphate and CV events after adjusted for comorbidities and renal function. Phosphate around 3.2 ± 0.1mg/dL was associated with the lowest CV risk. In Cox analysis, each 1 mg/dL increases in phosphate was associated with a higher risk of MACE+HHF (HR:1.12, 95% CI:1.05-1.21): CV death (HR: 1.37,95% CI: 1.22-1.55) and HHF (HR: 1.12, 95% CI: 1.02-1.23). Subgroup analyses showed more prominent association between phosphate and MACE+HHF in male, age > 65, bare-metal stents (BMSs), LVEF< 50%, eGFR <60, LDL >70 mg/dL, and emergent PCI.ConclusionPhosphate has a J-curve association with the risk of CV events in CAD patients undergoing PCI that was independent of comorbidities and renal function.