Key result
Omitting discharge OAC in octogenarians with AF post-PCI is linked to ~330% higher MACE risk.
Why the study?
Does oral anticoagulation reduce major adverse cardiac events in octogenarian patients with atrial fibrillation undergoing percutaneous coronary intervention and stenting?
Cohort (n=604)
Does oral anticoagulation reduce major adverse cardiac events in octogenarian patients with atrial fibrillation undergoing percutaneous coronary intervention and stenting?
Odds Ratio: 4.3 (95% CI 1.3–14.6)
Absolute Event Rate: 28.9% vs 58.3%
p-value: p=0.02
In octogenarian patients with atrial fibrillation undergoing PCI, oral anticoagulation at discharge is associated with a significant reduction in major adverse cardiac events without increasing major bleeding.
OAC use was associated with lower MACE without excess bleeding in octogenarian AF-PCI patients; leaves open whether it should become standard pending RCTs.
BACKGROUND: a significant proportion of octogenarian patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI) with stenting. Dual antiplatelet therapy is recommended in these patients, requiring a period of triple therapy with dual antiplatelet agent plus oral anticoagulation (OAC). Concerns remain regarding the appropriateness of OAC in octogenarians. METHODS: we reviewed 604 patients (15.7% ≥80 years) with AF undergoing PCI. Clinical follow-up was performed, recording any bleeding episode, thrombo-embolism and major adverse cardiac events (MACE = death, acute myocardial infarction and/or revascularisation of target lesion). We compared octogenarian patients in relation to treatment with OAC at discharge. A secondary aim was to compare octogenarian patients with non-octogenarian patients in terms of their clinical and demographic characteristics, management and clinical outcome. RESULTS: among the 604 patients, 95(15.7%) were aged ≥80 years. Octogenarians had a higher median CHADS2 score (2.78 versus 2.01; P < 0.001) and HAS-BLED score (3.05 versus 2.84; P = 0.028). After a follow-up of 17 ± 14 months, all-cause death occurred in 33%, MACE in 44%, and major bleeding in 21%. OAC was associated with less MACE (28.9 versus 58.3%; P = 0.012) and a similar rate of major bleeding. On multivariable analysis, non-use of OAC at discharge was associated with increased MACE (OR = 4.3; 95% CI = 1.3-14.6; P = 0.02). CONCLUSION: octogenarian AF patients undergoing PCI/stenting have a high mortality rate and MACE, which can be reduced by means of OAC therapy.
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Caballero et al. (2012) conducted a cohort in Atrial fibrillation undergoing percutaneous coronary intervention (n=604). Oral anticoagulation (OAC) vs. Non-use of OAC was evaluated on Major adverse cardiac events (death, acute myocardial infarction and/or revascularisation of target lesion) (OR 4.3, 95% CI 1.3-14.6, p=0.02). Non-use of oral anticoagulation at discharge in octogenarian patients with atrial fibrillation undergoing PCI was associated with increased MACE (OR 4.3; 95% CI 1.3-14.6; P=0.02).
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