Abstract 19269: Impact of Recommedations of Guidelines in Patients with Atrial Fibrillation Submitted for Coronary Stenting

Abstract

Objetive: to assess the impact of dual antiplatelet therapy (DAT) with clopidogrel and ASA vs. DAT with warfarin (triple therapy: TT) in patients with nonvalvular AF submitted to coronary stenting and the impact of CHADS2 and CHA2DS2VASc scores. Methods: a retrospective multicenter study was conducted from 2007 to 2011 to identify patients with nonvalvular AF who undergoing PCI with stenting. Patients basic characteristics, CHADS2 score, CHA2DS2VASc score, PCI details, antithrombotic therapy at discharge and its duration were recorded. Follow-up was 1 year. All bleeding events, stroke, thromboembolism, death, acute myocardial infarction or target revascularization were recorded. Results: We identified 489 patients with AF (74.8% male, 73.11±8 years); 307 (62.8%) received TT and 182 (37.2%) received DAT. Duration of DAT and TT was: 5.15±4 and 4.49±2.85 months, respectively. Baseline characteristics were similar in both groups, except for a higher rate of previous stroke (9.6% vs 16.8%, p=0.018) and previous PCI (44.5 % vs 25.4%, p=0.0001) in TT group. Patients treated with TT showed a trend to a higher rate of CHADS2 score ≥2 (64.8% vs 35.2%, p=0.17) and for CHA2DS2VASc ≥2 (64.3% vs 35.2%, p=0.25). Major bleeding and cardiovascular death were more frequent in patients with TT (6.7% vs 1.7%, p=0.01; 7% vs 2.9%, p=0.042, respectively). Stroke rate was more frequent in patients with DAT (5.7% VS 1.3%, p=0.008). In these patients CHADS score was median 2 (range 1-4) and CHA2DS2VASc median 4.5 (range 3-5). 44 patients (9.2%) died during follow-up.13 (29.2%) of them had had a bleeding event; 3 of them had CHADS2=1. Multivariate analysis identified as independent predictors for cardiovascular death: previous stroke (OR 5.7; 95% CI 0.9-34.6, p=0.05), drug eluting stent (OR:0.35; 95% CI 0.13-0.96, p=0.03) and TT (OR 0.35; 0.12-1.00, p=0.05). CHADS2 and CHA2DS2VASc scores were not predictors (OR 1.86: 95% CI 0.93-1.77, p=0.076; OR 1.32; 95% CI 0.92-1.89, p=0.123, respectively). Conclusions: In patients with nonvalvular AF who undergo PCI with stenting, the decisions of treatment with DAT or TT is not always influenced by CHADS or CHA2DS2VASc. There is a high incidence of bleeding with TT and a high incidence of stroke with DAT.