Key result
Triple therapy was associated with a significantly higher risk of the composite clinical outcome (HR 1.46) compared to oral anticoagulation with or without single antiplatelet therapy beyond 1-year after PCI in Asian patients with atrial fibrillation.
Why the study?
The prognostic impact of antithrombotic regimens at 1-year after PCI among patients with AF was unclear.
Does OAC±SAPT improve composite clinical outcomes compared to triple therapy or antiplatelet therapy alone in patients with atrial fibrillation beyond 1-year after PCI?
Cohort (n=13,278)
Does OAC±SAPT improve composite clinical outcomes compared to triple therapy or antiplatelet therapy alone in patients with atrial fibrillation beyond 1-year after PCI?
Hazard Ratio: 1.46 (95% CI 1–2.13)
Absolute Event Rate: 4.2% vs 2.9%
In Asian patients with atrial fibrillation beyond 1-year after PCI, OAC with or without single antiplatelet therapy is associated with better net clinical outcomes compared to prolonged triple therapy or antiplatelet therapy alone.
Prolonged triple therapy was associated with higher composite risk beyond 1 year post-PCI in AF; hypothesis-generating for OAC±SAPT preference, needs RCT confirmation.
BACKGROUNDS: We investigated the prognostic impact of antithrombotic regimens at 1-year after percutaneous coronary intervention (PCI) among patients with atrial fibrillation (AF). METHOD AND RESULTS: A 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. CONCLUSIONS: OAC±SAPT was associated with better clinical outcomes compared to TT or APT only treatments, beyond 1-year after PCI among Asians with AF.
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Park et al. (2020) conducted a cohort in Atrial fibrillation after percutaneous coronary intervention (n=13,278). Triple therapy (TT) vs. Oral anticoagulation with or without single antiplatelet therapy (OAC±SAPT) was evaluated on Composite clinical outcome (composite ischaemia and bleeding) (HR 1.46, 95% CI 1.00-2.13). Triple therapy was associated with a significantly higher risk of the composite clinical outcome (HR 1.46) compared to oral anticoagulation with or without single antiplatelet therapy beyond 1-year after PCI in Asian patients with atrial fibrillation.
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