Abstract
BackgroundsWe investigated the prognostic impact of antithrombotic regimens at 1-year after percutaneous coronary intervention (PCI) among patients with atrial fibrillation (AF).Method and resultsA total of 13,278 AF patients who underwent PCI from 2009 to 2013 were selected from Korean National Health Insurance Service database. Patients were categorized by antithrombotic regimens at 1-year after PCI: (1) OAC with or without single antiplatelet (OAC±SAPT); (2) triple therapy (TT) and (3) antiplatelets (APT) only. After propensity score matching, composite ischaemia (death, myocardial infarction, and stroke), composite bleeding (intracranial hemorrhage and gastrointestinal bleeding), and a composite clinical outcome (composite ischaemia and bleeding) were compared. Of total population, 1,100 (8.3%), 746 (5.6%), and 11,432 (86.1%) were treated with OAC±SAPT, TT, and APT only, respectively. Compared to OAC±SAPT group, the TT group had significantly higher risk of the composite clinical outcome (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.00–2.13) attributed to a higher trend in both ischaemia (HR 1.63, 95% CI 0.99–2.67) and bleeding (HR 1.22, 95% CI 0.69–2.13). The APT only group showed a higher risk of ischaemia (HR 1.85, 95% CI 1.25–2.74), despite a lower risk of bleeding (HR 0.55, 95% CI 0.32–0.94) compared to OAC±SAPT group.ConclusionsOAC±SAPT was associated with better clinical outcomes compared to TT or APT only treatments, beyond 1-year after PCI among Asians with AF.
Highlights
oral anticoagulants (OAC)±SAPT was associated with better clinical outcomes compared to triple therapy (TT) or APT only treatments, beyond 1-year after percutaneous coronary intervention (PCI) among Asians with atrial fibrillation (AF)
Patients with atrial fibrillation (AF) at moderate to high risk of stroke are recommended for stroke prevention with oral anticoagulants (OAC) and for those who underwent percutaneous coronary intervention (PCI), combination antithrombotic therapy with OAC and antiplatelets (APT) is required [1,2,3]
Our principal findings are as follows: (i) most patients (86.1%) did not receive OAC at 1-year after PCI though most of them were clinically indicated for anticoagulation (95.2% with CHA2DS2-VASc score 2); (ii) only a minority of patients (1.4%) received OAC monotherapy at 1-year after PCI, different from guideline recommendations; (3) patients with OAC were associated with a lower risk of composite ischaemic events despite a higher bleeding risk compared to those with APT only; and (iv) patients with APT only were associated with a significantly higher risk of the composite ischaemic outcome and a lower risk of the composite bleeding outcome, when compared to those with OAC±SAPT
Summary
Patients with atrial fibrillation (AF) at moderate to high risk of stroke are recommended for stroke prevention with oral anticoagulants (OAC) and for those who underwent percutaneous coronary intervention (PCI), combination antithrombotic therapy with OAC and antiplatelets (APT) is required [1,2,3]. Previous studies reported an under-prescription of OAC in patients with AF after PCI, especially among the Asian population [4,5,6,7]. This relates to concerns that Asians with AF tend to have a higher risk of stroke and more seriously, intracranial hemorrhage when compared to non-Asians [8]. The Optimizing Antithrombotic Care in Patients With AtriaL fibrillatiON and Coronary stEnt (OAC-ALONE) trial was conducted comparing the efficacy and safety benefit of OAC alone versus dual therapy (OAC plus SAPT) among Asian patients with AF beyond 1-year after PCI [10]. We sought to investigate the treatment patterns and the prognostic impact of different antithrombotic therapy regimes on ischaemic and bleeding events, at 1-year after PCI among patients with AF
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