452 ONE-YEAR OUTCOMES OF DIFFERENT ANTITHROMBOTIC STRATEGIES IN OLDEST OLD STEMI PATIENTS WITH NEW ONSET ATRIAL FIBRILLATION

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Abstract Introduction Management of antithrombotic therapy (ATT) in oldest old STEMI patients undergoing percutaneous coronary intervention (PCI) with new onset atrial fibrillation (NOAF) is a clinical conundrum given the gamut of possible ATT strategies and the lack of studies in this population. We sought to evaluate ATT patterns at discharge and 1-year outcomes in our center. Methods A retrospective cohort study of all consecutive oldest old (i.e. over 85 years) STEMI patients undergoing primary PCI (pPCI) was performed at our institution. NOAF was defined according to its documentation within 48 hours of STEMI diagnosis. Primary outcomes were 1-year major adverse cardiac or cerebrovascular events (MACCE: composite of death, myocardial infarction, stroke, heart failure hospitalization) and major bleeding events (Bleeding Academic Research Consortium 3 or 5). Results Among the 248 patients studied, NOAF was detected in 25.4% of patients (mean patient age 88.9±2.4 years, 56.5% females). At logistic regression analysis, baseline chronic kidney disease (eGFR<60 ml/min) was associated to nAF (OR: 2.38, 95% CI: 1.3 to 4.2; p<0.05).The development of heart failure during hospitalization was statistically higher in patients with nAF compared to patients without nAF (p=0.05). At discharge, triple therapy (TT: 1 anticoagulant and 2 antiplatelet agents) was prescribed in 11.5%, dual antiplatelet therapy (DAPT) in 77% and dual therapy (1 anticoagulant plus 1 antiplatelet agent) in 11.5% of patients. No group differences by ATT strategy were observed in 1-year MACCE (TT 32% vs dual therapy 27.2% vs DAPT 25.7%; p=0.81), or BARC 3,5 (TT 8% vs dual therapy 12.8% vs DAPT 9%; p=0.74). Conclusions The high incidence of NOAF in oldest old STEMI patients highlights the need of an adequate calibration between ischaemic and bleeding risk. Despite differences in the choice of ATT strategy, there were no significant differences in clinical outcomes up to 1 year.