Valle Felipe H, Goodman Shaun G, Tan Mary, Ha Andrew, Mansour Samer, Welsh Robert C, Yan Andrew T, Bainey Kevin R, Rinfret Stephane, Potter Brian J, Khan Razi, Simkus Gerald, Natarajan Madhu K, Schwalm J D, Daneault Benoit, Eisenberg Mark J, Abunassar Joseph, Har Bryan, Gregoire Jean, Tanguay Jean-Francois, Overgaard Christopher B, Dery Jean-Pierre, De Larochelliere Robert, Paradis Jean-Michel, Madan Mina, Elbarouni Basem, So Derek Y F, Quraishi Ata-Ur-Rehman, Bagai Akshay
Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Canadian Heart Research Centre, Toronto, Ontario, Canada.
CJC Open. 2021 Jul 6;3(12):1419-1427. doi: 10.1016/j.cjco.2021.07.003. eCollection 2021 Dec.
In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding.
We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the ordinated ational etwork to ngage Interventional ardiologists in the Antithrombotic reatment of Patients With trial ibrillation Undergoing ercutaneous oronary ntervention) study, to determine patterns of initial antithrombotic therapy selection.
The median (25th, 75th percentile) CHADS score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, = 0.045) and prior PCI (33.8% vs 23.3%, = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, = 0.32).
Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention.
在接受经皮冠状动脉介入治疗（PCI）的心房颤动（AF）患者中，选择抗血栓治疗方案需要平衡缺血性心脏事件、中风和出血的风险。
我们研究了2015年12月至2018年7月期间47位加拿大心脏病专家通过图表审核确定的467例接受PCI的AF患者，这些患者来自CONNECT AF+PCI（协调国家网络，让介入心脏病专家参与接受经皮冠状动脉介入治疗的房颤患者的抗血栓治疗试验）研究，以确定初始抗血栓治疗选择的模式。
CHADS评分中位数（第25、75百分位数）为2（1，3），62.1%的患者在急性冠状动脉综合征背景下接受PCI。三联抗血栓治疗（TAT）是62.7%患者的初始治疗，双途径治疗为25.7%，双联抗血小板治疗为11.6%，在研究过程中双途径治疗的使用呈时间性增加；TAT预期持续时间中位数为1（1，3）个月。与选择TAT的患者相比，选择双途径治疗的患者既往心肌梗死的可能性较小（35.8%对25.8%，P = 0.045），既往PCI的可能性也较小（33.8%对23.3%，P = 0.03），并且他们接受的支架总长度较短（38 [23，56]对30 [20，46] mm，P = 0.03）。选择双途径治疗的患者既往中风/短暂性脑缺血发作的患病率较高（13.0%对23.3%，P = 0.01）。贫血患病率无差异（21.5%对25.8%，P = 0.30）。急性冠状动脉综合征患者和稳定疾病患者中双途径治疗的使用相似（24.1%对28.2%，P = 0.32）。
在加拿大的实践中，约四分之一接受PCI的AF患者接受双途径治疗，在研究期间其使用有所增加。选择双途径治疗的患者冠心病病史和干预复杂性较低。
