Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
J Cardiol. 2023 Sep;82(3):207-214. doi: 10.1016/j.jjcc.2023.06.002. Epub 2023 Jun 17.
The efficacy and safety of dual antithrombotic therapy (DAT) with oral anticoagulant and P2Y12 inhibitors (P2Y12i) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not been well investigated. The purpose of this study was first to evaluate clinical outcomes of DAT with P2Y12i compared with triple antithrombotic therapy (TAT), and then to compare DAT with low-dose prasugrel and DAT with clopidogrel, in patients with AF undergoing PCI.
This study was a multicenter, non-interventional, prospective and retrospective registry. A total of 710 patients with AF undergoing PCI between January 2015 and March 2021 at 15 institutions were analyzed. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE) and major bleeding events (BARC 3 or 5) were compared between patients receiving DAT (n = 239) and TAT (n = 471), and then, compared among prasugrel-DAT (n = 82), clopidogrel-DAT (n = 157), and TAT.
The DAT group showed significantly lower incidence of MACE and major bleeding events compared with the TAT group (log-rank p = 0.013 and 0.047). In the multivariable Cox regression analyses, DAT (p = 0.028), acute coronary syndrome (p = 0.025), and anemia (p = 0.015) were independently associated with MACE. In addition, anemia (p = 0.022) was independently associated with, and DAT (p = 0.056) and thrombocytopenia (p = 0.051) tended to be associated with, major bleeding events. When analyzed among the prasugrel-DAT, clopidogrel-DAT, and TAT groups, there were no significant differences in clinical outcomes between the prasugrel-DAT and clopidogrel-DAT groups, and similar trends were observed for both 2 groups in comparison with the TAT group.
In AF patients undergoing PCI, DAT was associated with lower incidence of MACE and major bleeding events compared with TAT. In comparison of P2Y12i, there might be no significant difference in the incidence of MACE and bleeding events between prasugrel-based DAT and clopidogrel-based DAT.
在接受经皮冠状动脉介入治疗（PCI）的心房颤动（AF）患者中，口服抗凝药和 P2Y12 抑制剂（P2Y12i）的双联抗栓治疗（DAT）的疗效和安全性尚未得到充分研究。本研究的目的首先是评估与三联抗栓治疗（TAT）相比，P2Y12i 的 DAT 的临床结局，然后比较 AF 患者 PCI 中低剂量普拉格雷的 DAT 和氯吡格雷的 DAT。
这是一项多中心、非干预性、前瞻性和回顾性登记研究。在 15 个机构于 2015 年 1 月至 2021 年 3 月期间接受 PCI 的 710 名 AF 患者被纳入分析。比较 DAT（n=239）和 TAT（n=471）患者 1 年内主要不良心血管事件（MACE）和主要出血事件（BARC 3 或 5），然后比较普拉格雷-DAT（n=82）、氯吡格雷-DAT（n=157）和 TAT。
与 TAT 组相比，DAT 组的 MACE 和主要出血事件发生率显著降低（log-rank p=0.013 和 0.047）。多变量 Cox 回归分析显示，DAT（p=0.028）、急性冠状动脉综合征（p=0.025）和贫血（p=0.015）与 MACE 独立相关。此外，贫血（p=0.022）与主要出血事件独立相关，而 DAT（p=0.056）和血小板减少症（p=0.051）与主要出血事件也有一定的相关性。在普拉格雷-DAT、氯吡格雷-DAT 和 TAT 组之间进行分析时，与 TAT 组相比，普拉格雷-DAT 和氯吡格雷-DAT 组之间的临床结局无显著差异，且两组均有类似的趋势。
在接受 PCI 的 AF 患者中，与 TAT 相比，DAT 与较低的 MACE 和主要出血事件发生率相关。与 P2Y12i 比较，基于普拉格雷的 DAT 和基于氯吡格雷的 DAT 在 MACE 和出血事件的发生率方面可能无显著差异。
