TY - JOUR
T1 - A novel risk score to identify the need for triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention
T2 - a post hoc analysis of the RE-DUAL PCI trial
AU - Zwart, Bastiaan
AU - Bor, Willem Lambertus
AU - de Veer, Anne Johanna Wilhelmina Maria
AU - Mahmoodi, Bakhtawar Khan
AU - Kelder, Johannes Christiaan
AU - Lip, Gregory Y.H.
AU - Bhatt, Deepak L.
AU - Cannon, Christopher P.
AU - Ten Berg, Jurriën Maria
PY - 2022/7/22
Y1 - 2022/7/22
N2 - BACKGROUND: Current guidelines recommend treating atrial fibrillation (AF) patients who undergo percutaneous coronary intervention (PCI) with triple antithrombotic therapy (TAT) for up to one month in patients at high thrombotic risk. It is unclear how to select these high-risk patients. AIMS: The aim of this study was to identify patients at high thrombotic risk who might benefit from TAT over double antithrombotic therapy (DAT). METHODS: This study was a post hoc subanalysis of the RE-DUAL PCI trial. A Cox proportional hazards model was built by stepwise selection of plausible predictor variables for a composite ischaemic endpoint, defined as cardiovascular death, myocardial infarction (MI), stent thrombosis (ST) or ischaemic stroke. The effect of TAT versus DAT was calculated for those patients with the highest proportion of predicted thrombotic risk. A simplified risk score was constructed based on beta-coefficients. RESULTS: For 209 patients (7.7%) the composite ischaemic endpoint occurred during the first year. The simplified risk score contained six variables. In patients with a score ≥5 (n=154, 5.7%), a significant reduction in the composite of MI and ST was observed with TAT versus DAT (6.3% vs 21.0%, p=0.041), without a penalty in terms of bleeding. In patients at low thrombotic risk, a significant increase in bleeding was observed without a reduction of ischaemic events. CONCLUSIONS: Our findings support the use of DAT in the majority of patients. A small subgroup of patients might benefit from TAT and we propose a novel clinical risk score to select these patients.
AB - BACKGROUND: Current guidelines recommend treating atrial fibrillation (AF) patients who undergo percutaneous coronary intervention (PCI) with triple antithrombotic therapy (TAT) for up to one month in patients at high thrombotic risk. It is unclear how to select these high-risk patients. AIMS: The aim of this study was to identify patients at high thrombotic risk who might benefit from TAT over double antithrombotic therapy (DAT). METHODS: This study was a post hoc subanalysis of the RE-DUAL PCI trial. A Cox proportional hazards model was built by stepwise selection of plausible predictor variables for a composite ischaemic endpoint, defined as cardiovascular death, myocardial infarction (MI), stent thrombosis (ST) or ischaemic stroke. The effect of TAT versus DAT was calculated for those patients with the highest proportion of predicted thrombotic risk. A simplified risk score was constructed based on beta-coefficients. RESULTS: For 209 patients (7.7%) the composite ischaemic endpoint occurred during the first year. The simplified risk score contained six variables. In patients with a score ≥5 (n=154, 5.7%), a significant reduction in the composite of MI and ST was observed with TAT versus DAT (6.3% vs 21.0%, p=0.041), without a penalty in terms of bleeding. In patients at low thrombotic risk, a significant increase in bleeding was observed without a reduction of ischaemic events. CONCLUSIONS: Our findings support the use of DAT in the majority of patients. A small subgroup of patients might benefit from TAT and we propose a novel clinical risk score to select these patients.
KW - Anticoagulants/therapeutic use
KW - Atrial Fibrillation/complications
KW - Brain Ischemia
KW - Drug Therapy, Combination
KW - Fibrinolytic Agents/therapeutic use
KW - Hemorrhage/etiology
KW - Humans
KW - Myocardial Infarction/etiology
KW - Percutaneous Coronary Intervention/adverse effects
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Risk Factors
KW - Stroke/etiology
KW - Thrombosis/etiology
KW - risk stratification
KW - myocardial infarction
KW - atrial fibrillation
KW - percutaneous coronary intervention
KW - stent thrombosis
KW - antithrombotic treatment
UR - http://www.scopus.com/inward/record.url?scp=85129773279&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-21-00165
DO - 10.4244/EIJ-D-21-00165
M3 - Journal article
C2 - 35105533
SN - 1774-024X
VL - 18
SP - e292-e302
JO - EuroIntervention
JF - EuroIntervention
IS - 4
ER -