Abstract 19207: Outcomes in Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting With a Low-moderate Cha2ds2vasc Score. Do They Need Anticoagulation?
Background: European Society of Cardiology guidelines for the management of atrial fibrillation (AF) recommend oral anticoagulation (OAC) in patients with CHA2DS2VASc score ≥1. When in these patients a coronary stent (CS) is implanted, indication to dual antiplatelet therapy (DAPT) is added, so these patients may be receiving triple therapy (TT). Objective: We assessed the impact of TT in patients with non-valvular AF and a low-moderate thromboembolic risk (CHA2DS2VASc < 2) submitted to coronary stenting (CS).
Methods: a retrospective multicenter study was conducted from 2007 to 2011 to identify patients with nonvalvular AF who undergoing PCI with stenting. Patients clinical and demographic characteristics,CHADS2VASC2 score, PCI details, antithrombotic therapy at discharge and its duration. Follow-up was 1 year. Clinical outcomes were obtained from hospital readmissions and/or outpatients clinic interview were also reviewed. All bleeding events, stroke, thromboemobolism, death, acute myocardial infarction or target revascularization were recorded.
Results: We identified 640 consecutive patients with nonv-valvular AF (75.2% male, 73.2±8.2 years). Of them 170 (27%) had a CHA2DS2VASc 3 (7.6% vs 4.2%; p=0.29). At follow-up, patients on TT showed a higher mortality (1.3% vs 8.4%, p=0.03) due an excess of cardiovascular death (0% vs 8.4%, p=0.008), and a higher rate of major bleeding (0% vs 5.3%, p=0.05). However, they showed a similar rates of thromboembolic events (1.3% vs 1.1%, p=0.68), MACE (9.3% vs 13.7%, p=0.26) and MAE (18.7% versus 26.3%, p=0.16) compared to patients on DAPT. A total of 9 patients (5.3%) died during follow-up; 8 (88.9%) of them were on TT, 4 patients had a bleeding event, and 3 of them had a CHA2DS2VASc=1. In a multivariate analysis, in patients with CHA2DS2VASc < 2, the use of TT showed a trend towards increased mortality (OR 8.4; 95% CI: 0.91 to 77.6, p=0.05), and was a predictor of major bleeding (OR 2.9: 1.04-8.25, p=0.042).
Conclusions: In patients with non-valvular AF and CHA2DS2VASc <2 submitted to CS, the addition of OAC to DAPT shows a trends to increases mortality as well as the rate of major bleeding, and does not provide any apparent benefit preventing thromboembolic events.
- © 2013 by American Heart Association, Inc.