Clinical characteristics, antithrombotic strategies, and outcomes in patients with atrial fibrillation and coronary heart disease undergoing percutaneous coronary intervention: a multicenter real-world study in Chongqing, China

Atrial fibrillation (AF) with coronary artery disease (CAD) requiring percutaneous coronary intervention (PCI) — including both acute and chronic presentations — is common, yet the optimal antithrombotic regimen remains unclear. This study aimed to characterize clinical features, current antithrombotic therapy, and discharge prognosis in this population. Data were collected from three independent annual cohorts of patients with atrial fibrillation and coronary heart disease undergoing PCI (2013, 2018, and 2023). First, cross-sectional comparisons across the three years were performed to examine temporal trends in clinical characteristics and discharge antithrombotic therapy. Predictors of discharge antithrombotic therapy were then analyzed in the 2023 cohort. Second, the 2023 cohort was prospectively followed for a median of 17 months (interquartile range 9–24 months; range 0.5–32 months) to evaluate clinical outcomes according to different antithrombotic regimens and to identify independent risk factors. Of the 1,062 participants, 479 underwent longitudinal follow-up (median 17 months, IQR 9–24; range 0.5–32). Independent predictors of intensified antithrombotic therapy included recent PCI, proton pump inhibitor use, and statin use; independent predictors of antiplatelet therapy included recent PCI, age, liver dysfunction, left atrial diameter, proton pump inhibitor use, heart failure, and non-paroxysmal atrial fibrillation. During follow-up, anticoagulant therapy showed a trend toward higher MACCEs risk compared with intensified antithrombotic therapy (HR 1.47, 95% CI 0.97–2.24, P =0.073) and antiplatelet therapy (HR 1.33, 95% CI 0.79–2.22, P =0.280), with no significant difference between the latter two (HR 1.15, 95% CI 0.71–1.88, P =0.567). Multivariate Cox regression identified liver dysfunction, diabetes, and HAS-BLED score as independently associated with MACCEs, while higher hemoglobin and statin use were associated with lower risk. Over the years, more AF with CHD patients after PCI received post-discharge antithrombotic therapy. Liver dysfunction, diabetes, and a high HAS‑BLED score were independently associated with MACCEs, while statin use was associated with lower risks of all‑cause death, MI, and ischemia‑driven revascularization.