Abstract 13775: Dual vs. Triple Antithrombotic Therapy After Coronary Stenting in Patients With Non-Valvular Atrial Fibrillation
Introduction: Atrial fibrillation (AF) is common (10-15%) in patients undergoing percutaneous coronary intervention (PCI) and presents a challenge as the optimal antithrombotic therapy is unknown.
Methods: We followed 500 consecutive patients with non-valvular AF with CHA2DS2VASC scores >1 undergoing PCI between 2009 and 2011 and compared major adverse cardiovascular events (MACCE = death, myocardial infarction (MI), revascularization, stroke, peripheral embolism or stent thrombosis), and net adverse clinical events (NACE = MACCE + major bleeding) on dual antiplatelet therapy (DAPT = aspirin + clopidogrel), vs. triple therapy (TT = daily ASA + alternate-day clopidogrel) plus an oral anticoagulant.
Results: Baseline characteristics including age, gender, and bare-metal stents were balanced between the DAPT (49%) and TT (51%) groups. Patients on TT more often had permanent AF (66% vs 39%; P<0.01), 1-vessel disease (37% vs. 29% P=0.04), and less often acute MI presentation (12% vs. 19%, P=0.02), and complex, calcific coronary disease (20% vs. 28%, P=0.04), or bifurcation lesions (2% vs. 7%, P=0.01). Triple therapy was associated with a lower rate of MACCE (18% vs. 26%, P=0.04, Figure 1.), and NACE (20 vs. 27%, P=0.05) at 1-year. This was confirmed after multivariate Cox-regression analysis adjusted for baseline covariates (P=0.02). There was no significant difference in the rate of stroke 1.3% vs. 0.4% or major bleeding 3% vs. 2% for TT and DAPT, respectively.
Conclusions: Compared to DAPT, TT reduces ischemic events in patients with AF undergoing PCI, predominantly due to the reduction of unplanned revascularization.
- Atrial fibrillation
- Percutaneous coronary intervention
- Antiplatelet drugs
- Coronary heart disease
- © 2013 by American Heart Association, Inc.