Abstract 12011: Time in Therapeutic Range and Major Adverse Outcomes in Anticoagulated Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention on Triple Antithrombotic Therapy: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) Registry

Abstract

Introduction: Combination of oral anticoagulation (OAC) and antiplatelet therapy is used in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention stent (PCI-S) implantation but is associated with increased bleeding, especially if triple antithrombotic therapy (TAT) is used. Hypothesis: Adverse outcomes in patients prescribed with TAT after a PCI-S are related to quality of anticoagulation control as reflected by time in therapeutic range (TTR). Methods: Subgroup analysis from the AFCAS registry in patients assigned to TAT at discharge. TTR was calculated using Rosendaal method. Outcomes were determined for TTR tertiles (T1:<56.8%, T2:56.9-93.8%, T3:>93.9%). Results: Of 963 patients originally enrolled, 470 (48.8%) were prescribed TAT at discharge and had all data available for this analysis. Median [IQR] TTR was 80.0% [45.3-100%]. After a mean±SD follow-up of 343±94 days, crude major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, p=0.006). Kaplan Meier survival analysis demonstrated a progressively lower risk for major bleeding across TTR tertiles (p=0.006; Figure). Patients in the highest TTR tertile (T3) had a lower risk for major adverse coronary and cerebrovascular events (MACCE) compared to those in T1 and T2 (Log-Rank:4.420, p=0.036). On Cox regression analysis (adjusted for age, gender, AF type, CHA 2 DS 2 -VASc, PCI-S indication/setting), T2 and T3 were inversely associated with major bleeding (HR:0.39, 95%CI:0.15-1.00, p=0.050 and HR:0.21, 95%CI:0.07-0.63, p=0.005). Continuous TTR was also inversely associated with major bleeding (HR:0.98, 95%CI:0.97-0.99, p<0.001). Patients in T3 had the lowest risk of MACCE (HR:0.58, 95%CI:0.35-0.96, p=0.033). Conclusions: In AF patients undergoing a PCI-S prescribed TAT, good quality anticoagulation control (as reflected by TTR) is related to better cardiovascular and bleeding outcomes during follow-up.