Abstract 16802: Should We Recommend Triple Therapy in Elderly Patients With Atrial Fibrillation Undergoing Coronary Stenting?
ACC/AHA/ESC recommends triple therapy (TT: anticoagulation and DAPT with ASA and Clopidogrel) for patients in atrial fibrillation (AF) submitted to coronary stenting (CS). However, a high percentage of these patients are elderly and the impact of this strategy in this setting is unknown.
Purpose: to assess the impact of TT in patients AF ≥ 75 years with non-valvular submitted to CS.
Methods: a prospective multicenter study was conducted from 2007 to 2011 to identify patients with non-valvular AF submitted to CS. During 1 year of follow-up, we determined patients bleedings, strokes, thromboembolisms, death, acute myocardial infarction or target vessel revascularization. Clinical outcomes were obtained "post hoc" from hospital readmissions and/or outpatients clinical interviews.
Results: We identified 640 patients with AF (50% ≥ 75 years, 79.8 ± 5.6 years, 69% women). Patients ≥ 75 years had more hypertension, diabetes, renal failure and previous stroke, and they more frequently had a CHA2DS2VASc > 2 (92.5% vs 53.4%, p <0.0001) and HASBLED> 3 (68.9% vs 31.1%, p <0.0001). However, the use of TT was similar in both age groups (49.8% in ≥ 75 years vs 50.0% in <75 years). Patients ≥ 75 years had a higher mortality (13.8% vs 5.9%, p<0.001), major bleedings (8.2% vs 3.4%; p=0.008), MACE (20.9% vs 13.8%; p=0.011) and MAE (35.3% vs 24.1%, p=0.001). In both age groups, similar rates of thromboembolic events were recorded (3.4% in ≥ 75 years vs 4.1% in <75 years, p = 0.41), but in the ones ≥ 75 years treated with TT a lower incidence of thromboembolism was recorded compared to those treated with DAPT (7.8 vs 0.6%, p=0.002). However, in those patients, TT carried out a higher rate of major bleeding than DAPT (9.3% vs 3.9%, p=0.05). A multivariate analysis identified as independent predictors of mortality in patients ≥ 75 years renal failure (OR 4.07, 95% CI 1.8 to 9.1; p=0.001), and heart failure (OR 2.4; 95% CI 1.09 to 5.3; p=0.029). TT treatment was a protective factor (OR 0.22; 95% CI 0.6-0.79, p = 0.02).
Conclusions: Patients ≥ 75 years have more comorbidities, a higher thromboembolic and hemorrhagic risk. Therefore, they present more unfavorable outcomes during follow-up. TT is associated with a reduced mortality, although carries out a higher rate of major bleeding.
- © 2013 by American Heart Association, Inc.