Bachorski Witold, Bychowski Jakub, Gruchała Marcin, Jaguszewski Miłosz
Department of Cardiology, Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdansk, Poland.
Diagnostics (Basel). 2023 Sep 26;13(19):3055. doi: 10.3390/diagnostics13193055.
Patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) treated with percutaneous coronary intervention (PCI) are at high risk of bleeding and thromboembolic events. Thus, optimal treatment strategies in this challenging subset have been controversial. Herein, we aim to investigate different triple antithrombotic treatment (TAT) strategies in patients with ACS and AF after PCI.
This was a retrospective, single-center study based on all consecutive patients with the diagnosis of ACS and AF treated with vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC) plus dual antiplatelet therapy using a P2Y12 inhibitor (clopidogrel) and aspirin (for 1 to 3 months) and observed for 12 months for major adverse cardiac events (MACE) and major or clinically relevant non-major bleeding incidents.
MACE occurred in 26.6% of patients treated with the VKA and 30.9% with NOAC ( = 0.659). Bleeding occurred in 7.8% of patients treated with VKA and 7.4% with NOAC (ns).
Among patients with ACS and AF who had undergone PCI, there was no significant difference in the risk of bleeding and ischemic events among those who received TAT with NOAC and VKA.
接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）和心房颤动（AF）患者发生出血和血栓栓塞事件的风险很高。因此，针对这一具有挑战性的亚组患者的最佳治疗策略一直存在争议。在此，我们旨在研究PCI术后ACS和AF患者不同的三联抗栓治疗（TAT）策略。
这是一项回顾性单中心研究，纳入所有连续诊断为ACS和AF且接受维生素K拮抗剂（VKA）或非维生素K拮抗剂口服抗凝剂（NOAC）加使用P2Y12抑制剂（氯吡格雷）和阿司匹林的双联抗血小板治疗（持续1至3个月）的患者，并观察12个月，记录主要不良心脏事件（MACE）和主要或临床相关的非主要出血事件。
接受VKA治疗的患者中26.6%发生MACE，接受NOAC治疗的患者中30.9%发生MACE（P = 0.659）。接受VKA治疗的患者中7.8%发生出血，接受NOAC治疗的患者中7.4%发生出血（无显著性差异）。
在接受PCI的ACS和AF患者中，接受NOAC和VKA进行TAT的患者在出血和缺血事件风险方面无显著差异。
