Abstract 14126: Safety and Efficacy of Anti-thrombotic Therapy After PCI in Octogenarians With Atrial Fibrillation: A Multi-center Study

Abstract

The purpose of the present study was to clarify the safety and efficacy of oral anticoagulation (OAC) in addition to dual antiplatelet therapy (DAPT) in octogenarians with atrial fibrillation (AF) undergoing PCI. Method and Result: We examined consecutive 360 AF patients registered at 8 medical centers who took DAPT or OAC + DAPT at the time of PCI. Octogenarians (n=77) were compared with those of younger patients (n=283). In octogenarians, acute coronary syndrome (octogenarians vs. younger patients = 54.6% vs. 37.4%) was more common and diabetes (32.5% vs. 45.6%) and usage of drug-eluting stent (58.4% vs. 73.1%) were less common (P<0.01, respectively). There was a significant difference in CHADS2 score (2.9±1.0 vs. 2.2±1.3, P<0.01) and no statistical difference HAS-BLED score (2.4±0.7 vs. 2.2±0.8). At 1-year, major adverse cerebro-cardiovascular events (MACCE) was significantly higher in octogenarians than in younger patients (16.9% vs. 3.9% P<0.01) and bleeding complications (defined as TIMI minor plus major) were similar (7.8% vs. 5.6% P=0.48). In octogenarians, there was a trend in lower cumulative incidence of MACCE in OAC+DAPT patients (n=44) compared to DAPT patients (n=33; 13.6% vs. 21.2% p=0.06), however, there was an excess risk of bleeding complications (13.6% vs. 0%, p=0.008). Conclusion: Octogenarians with AF undergoing PCI showed poor prognosis and were at high risk of bleeding, especially in patients who took OAC + DAPT. “Tailor-made” treatment strategies should be considered in this high-risk subset.