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. 2021 Jul 29;10(15):3370.
doi: 10.3390/jcm10153370.

Prognosis of Atrial Fibrillation Patients Undergoing PCI According to Anticoagulants and Antiplatelet Agents

Gwang-Seok Yoon  1   2 , Sun-Hwa Kim  1 , Si-Hyuck Kang  1   2 , Chang-Hwan Yoon  1   2 , Young-Seok Cho  1   2 , Tae-Jin Youn  1   2 , In-Ho Chae  1   2
Affiliations

Prognosis of Atrial Fibrillation Patients Undergoing PCI According to Anticoagulants and Antiplatelet Agents

Gwang-Seok Yoon et al. J Clin Med. .

Abstract

There are limited data evaluating conformation of antithrombotic therapy usage to the guideline recommendations. We investigated clinical trends and prognoses of patients with atrial fibrillation (AF) according to anticoagulants and antiplatelet agents beyond 1 year after percutaneous coronary intervention (PCI). We analyzed the records of patients with AF who underwent PCI using the Korean National Health Insurance Service database. The primary endpoint was a composite of major adverse cardiac events (MACE). The safety outcome was bleeding complications. Of 4193 participants, 81.6% received antiplatelet therapy, whereas 27.3% had oral anticoagulant (OAC)-based therapy at 18 months after PCI. The dominant therapy was dual antiplatelet therapy (37.2%), and only 3.3% of participants had OAC monotherapy. At the 1-year follow-up, the incidence of MACE was significantly lower among those receiving a combination of OAC and single antiplatelet therapy (SAPT) than among those receiving OAC monotherapy (4.78% vs. 9.42%, p = 0.017). Bleeding complication events (5.01% vs. 5.80%, p = 0.587) did not differ between the groups. In clinical practice, most patients with AF who underwent PCI continued to receive antiplatelet agents beyond 1-year post-PCI. OAC with SAPT seemed to be more effective than OAC monotherapy, without a difference in safety.

Keywords: anticoagulant; antiplatelet; atrial fibrillation; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study enrollment flow. AF, atrial fibrillation; hCVA, hemorrhagic cerebrovascular accident; iCVA, ischemic cerebrovascular accident; MI, myocardial infarction; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan–Meier Curves for primary efficacy and safety endpoints in the total study groups. (A) The primary efficacy outcome is MACE defined as a composite of all-cause death, myocardial infarction and stroke. (B) The safety outcome is bleeding events defined as an admission with an endoscopic or endovascular procedure for hemostasis or red blood cell transfusion. DAPT, dual antiplatelet therapy; MACE, major adverse cardiac events; OAC, oral anticoagulant; SAPT, single antiplatelet therapy.
Figure 3
Figure 3
Kaplan–Meier curves of the crude population and inverse probability of treatment weighting (IPTW) population for the clinical outcomes in OAC with SAPT and OAC monotherapy. MACE of (A) unadjusted and (B) IPTW-adjusted population; bleeding complication of (C) unadjusted and (D) IPTW-adjusted population. MACE, major adverse cardiac events; OAC, oral anticoagulant; SAPT, single antiplatelet therapy.
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