Abstract 16759: Outcomes of Triple Antithrombotic Therapy Compared to Dual Antiplatelet Therapy After Coronary Stenting: Up to 4 Years of Follow-Up
Background: Treatment in p (patients) who need oral anticoagulation and antiplatelet therapy after PCI (percutaneous coronary intervention) are from small and heterogeneous series. There are few data on long-term results. Our aim was to compare the long-term incidence of cardiovascular events (MACE: cardiac death, nonfatal MI, repeat revascularization and stroke) and bleeding (criteria BARC) between p with triple therapy (TT) and those with dual antiplatelet therapy (Non-TT) at discharge after PCI.
Methods: Prospective, observational study of 769 consecutive p undergoing PCI between Oct 2007-Apr 2011. The probability of assigning each p for each group was adjusted using propensity score. We compared the incidence of MACE and bleeding in both groups. Survival was evaluated using Kaplan-Meier and log-rank test, multivariate analysis using a proportional hazards model of Cox.
Results: 13.3% were included in the TT group (102p, age 72.7 ± 9.9 years; CHA2DS2-VASC 3.7±1.5; HASBLED 2.7±1.3) and 87.7% in the Non-TT (667p, age 65.5 ± 11.6 years; CHA2DS2-VASC 1.8±1.7, 1.1±1.1 HASBLED). During follow-up (26.5 ± 14.6 months), the cumulative incidence of MACE (28.4% vs. 19.9%, p=0.03), due to a higher incidence of stroke (11.9% vs 1.8%, p<0.05), Overall mortality rate (14.7% vs 9.7%, p=0.02) due to non-cardiac mortality (8.8% vs 4.0%, p=0.03) and the rate of bleeding (29.4% vs 8.4%, p<0.05) was unfavorable for the TT group. Most bleeding in both groups were clinically minor (BARC<3 24.5% vs 7.8%; BARC≥3 4.9% vs 0.5%), respectively. The average time to MACE was lower in the TT group versus Non-TT (40.9, 95%CI[36.4-45.4] vs 48.6, 95%CI[46.6-50.7] months, log-rank test p<0.05). There were no differences in the mean time to bleeding between the two groups (327±85 vs 414±67 days, log-rank test p=0.72).
Conclusions: In the long term, patients on triple therapy after PCI constitute a high-risk population with increased incidence bleeding of non-cardiac death and major cardiovascular events, due to high risk of stroke. Bleeding rate was higher in this group at the expense of minor bleeding.
- © 2013 by American Heart Association, Inc.