抗栓策略在经皮冠状动脉介入治疗的心房颤动和阻塞性冠状动脉疾病中的变异性：来自 AVIATOR 2 国际注册研究的主要结果。
Antithrombotic strategy variability in atrial fibrillation and obstructive coronary disease revascularised with percutaneous coronary intervention: primary results from the AVIATOR 2 international registry.
机构信息
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Box Hill Hospital, Eastern Health Clinical School and Monash University, Melbourne, Australia.
出版信息
EuroIntervention. 2022 Oct 7;18(8):e656-e665. doi: 10.4244/EIJ-D-21-01044.
BACKGROUND
Managing percutaneous coronary intervention (PCI) patients with atrial fibrillation (AF) presents challenges given that there are several potential antithrombotic therapy (ATT) strategies.
AIMS
We examined ATT patterns, agreement between subjective physician ratings and validated risk scores, physician-patient perceptions influencing ATT and 1-year outcomes.
METHODS
The AVIATOR 2 prospective registry enrolled 514 non-valvular AF-PCI patients from 11 sites. Treating physicians selected ATT and completed smartphone surveys rating stroke and bleeding risks, compared against CHADS-VASc and HAS-BLED scores. Patients completed surveys regarding treatment understanding. Primary outcomes were 1-year major adverse cardiac or cerebrovascular events (MACCE: composite of death, myocardial infarction, definite/probable stent thrombosis, stroke, target lesion revascularisation) and actionable bleeding (Bleeding Academic Research Consortium 2, 3 or 5).
RESULTS
The mean patient age was 73.2±9.0 years, including 25.8% females. Triple therapy (TT: 1 anticoagulant and 2 antiplatelet agents) was prescribed in 66.5%, dual antiplatelet therapy (DAPT) in 20.7% and dual therapy (1 anticoagulant+1 antiplatelet agent) in 12.8% of patients. Physician ratings and validated risk scores showed poor agreement (stroke: kappa=0.03; bleeding: kappa=0.07). Physicians rated bleeding-related safety (93.8%) as the main factor affecting ATT choice. Patients worried about stroke over bleeding (50.6% vs 14.8%). No group differences by ATT strategy were observed in 1-year MACCE (TT 14.1% vs dual therapy 12.7% vs DAPT 18.5%; p=0.25), or actionable bleeding (14.7% vs 7.9% vs 15.1%, respectively; p=0.89).
CONCLUSIONS
The AVIATOR 2 study is the first digital health study examining physician-patient perspectives on ATT choices after AF-PCI. TT was the most common strategy without differences in 1-year outcomes in ATT strategy. Physicians rated safety first when prescribing ATT; patients feared stroke over bleeding.
CLINICALTRIALS
gov: NCT02362659.
背景
管理合并心房颤动（AF）的经皮冠状动脉介入（PCI）患者具有挑战性，因为有几种潜在的抗血栓治疗（ATT）策略。
目的
我们研究了 ATT 模式、主观医生评分与经过验证的风险评分之间的一致性、影响 ATT 和 1 年结局的医生-患者认知。
方法
AVIATOR 2 前瞻性登记研究纳入了来自 11 个地点的 514 例非瓣膜性 AF-PCI 患者。治疗医生选择 ATT，并使用智能手机调查对卒中及出血风险进行评分，同时与 CHADS-VASc 和 HAS-BLED 评分进行比较。患者完成关于治疗理解的调查。主要结局为 1 年主要不良心脑血管事件（MACCE：死亡、心肌梗死、明确/可能的支架血栓形成、卒中、靶病变血运重建的复合事件）和可行动出血（BARC 2、3 或 5 级）。
结果
患者的平均年龄为 73.2±9.0 岁，包括 25.8%女性。三联治疗（TT：1 种抗凝剂和 2 种抗血小板药物）在 66.5%的患者中使用，双抗血小板治疗（DAPT）在 20.7%的患者中使用，双联治疗（1 种抗凝剂+1 种抗血小板药物）在 12.8%的患者中使用。医生评分和经过验证的风险评分显示一致性较差（卒中：kappa=0.03；出血：kappa=0.07）。医生将出血相关安全性（93.8%）评定为影响 ATT 选择的主要因素。患者担心卒中甚于出血（50.6% vs 14.8%）。ATT 策略的患者在 1 年 MACCE（TT 14.1% vs 双联治疗 12.7% vs DAPT 18.5%；p=0.25）或可行动出血（14.7% vs 7.9% vs 15.1%；分别为 p=0.89）方面无组间差异。
结论
AVIATOR 2 研究是第一项使用数字健康技术研究 AF-PCI 后医生-患者对 ATT 选择的看法的研究。TT 是最常见的策略，但在 ATT 策略中，1 年结局无差异。医生在开具 ATT 时首先考虑安全性；患者担心卒中甚于出血。
临床试验
gov：NCT02362659。
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