Impact of Stent Age on Antithrombotic Strategy for Atrial Fibrillation in Patients with Drug-eluting Stents

Although non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy is generally recommended beyond 1 year after drug-eluting stent (DES) implantation in patients with atrial fibrillation (AF), the temporal evolution of ischemic and bleeding risks remains inadequately characterized. This study assessed whether the effects of NOAC monotherapy versus combination therapy differ by stent age in patients with AF who underwent DES implantation ≥ 1 year earlier. This prespecified analysis of the Appropriate Duration of Anti-Platelet and Thrombotic Strategy After 12 Months in Patients with Atrial Fibrillation Treated with Drug-Eluting Stents (ADAPT AF-DES) trial compared NOAC monotherapy with combination therapy (NOAC plus clopidogrel) by stent age. Patients were classified into the remote percutaneous coronary intervention (PCI) group (stent age > 2 years; n = 577) and the intermediate PCI group (stent age 1–2 years; n = 383). The primary endpoint was 1-year net adverse clinical events (NACE). No significant interaction between antithrombotic strategy and stent age was found for NACE. NOAC monotherapy was associated with less major bleeding or clinically relevant nonmajor bleeding than combination therapy in both subgroups without interaction. Although a significant interaction was observed for composite ischemic outcomes in the prespecified analysis, it was no longer observed when stent age was modeled as a continuous variable or after adjustment in sensitivity analyses. Among patients with AF ≥ 1 year post-DES, no consistent interactions by stent age were observed for clinical outcomes, supporting the safety and effectiveness of NOAC monotherapy across the spectrum of stent age.