Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA.
Baim Institute for Clinical Research, 930 Commonwealth Ave#3, Boston, MA 02215, USA.
Eur Heart J. 2018 May 14;39(19):1726-1735a. doi: 10.1093/eurheartj/ehy162.
Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population.
A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57%) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47% in the DAT arm [4.3% vs. 9.0%; hazard ratio (HR) 0.53, 95% credible interval (CrI) 0.36-0.85, I2 = 42.9%]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4% vs. 10.0%, HR 0.85, 95% CrI 0.48-1.29, I2 = 58.4%), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms.
Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI.
在患有心房颤动（AF）的患者中，约有 10%接受经皮冠状动脉介入治疗（PCI）。我们研究了在这一人群中，双联抗栓治疗（DAT）与三联抗栓治疗（TAT）的安全性和有效性。
使用 PubMed、Embase、EBSCO、Cochrane 系统评价数据库、Web of Science 和相关会议摘要，对比较 AF 患者 PCI 后 DAT 与 TAT 的 3 期随机试验进行了系统评价和荟萃分析。共纳入 4 项试验 5317 例患者，其中 3039 例（57%）接受 DAT。与 TAT 组相比，DAT 组的血栓溶栓治疗（TIMI）大出血或小出血减少了 47%[4.3%比 9.0%；危险比（HR）0.53，95%可信区间（CrI）0.36-0.85，I²=42.9%]。此外，两组在试验定义的主要不良心脏事件（MACE）（10.4%比 10.0%，HR 0.85，95%CrI 0.48-1.29，I²=58.4%）或全因死亡率、心脏死亡、心肌梗死、支架血栓形成或卒中的个别结局方面均无差异。
与 TAT 相比，DAT 可使 TIMI 大出血或小出血减少 47%，而 MACE 结局相当。我们的研究结果支持 DAT 在许多接受 PCI 的 AF 患者中可能是比 TAT 更好的选择的观点。
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