Iwata Hiroshi, Miyauchi Katsumi, Nojiri Shuko, Nishizaki Yuji, Chikata Yuichi, Daida Hiroyuki
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
Int J Cardiol Cardiovasc Risk Prev. 2024 Oct 8;24:200339. doi: 10.1016/j.ijcrp.2024.200339. eCollection 2025 Mar.
The antithrombotic strategy for patients with atrial fibrillation (AF) and coronary artery disease following percutaneous coronary intervention is shifting towards less intensive. Nevertheless, for patients with AF and acute coronary syndrome (ACS), an optimal antithrombotic strategy is yet to be established.
We conducted a multi-center cohort study involving 146 Japanese centers that had prospectively registered 460 patients with AF and ACS followed for 2 years. Primary endpoint was the composite of thrombotic and bleeding events, and secondary endpoints included heart failure hospitalization. At the time of study registration, 86 % of participants had received direct oral anticoagulants (DOACs) and 75 % had received aspirin-based triple antithrombotic therapy (TAT) between March 2017 and August 2019. Apixaban was the most frequently used DOAC (29 %). While the proportion of anticoagulants did not change according to the time course, the intensity of antiplatelets significantly attenuated over time (dual antiplatelet at baseline: 75 %, and at 2-years: 7 %). The cumulative incidence of the primary outcome measure was similar in patients with warfarin and DOACs. However, the risk of heart failure hospitalization was significantly higher in those with warfarin compared to DOACs (Hazard ratio: 2.8, 95 % confidence interval: 1.1-5.8, p = 0.022).
The present findings suggest the appropriate optimization of antithrombotic medication balancing in patients with AF and ACS in Japan by reducing the intensity of antiplatelets during the study period.
经皮冠状动脉介入治疗后，心房颤动（AF）合并冠状动脉疾病患者的抗栓策略正朝着强度较低的方向转变。然而，对于AF合并急性冠状动脉综合征（ACS）的患者，最佳抗栓策略尚未确立。
我们进行了一项多中心队列研究，涉及146个日本中心，这些中心前瞻性登记了460例AF合并ACS患者，随访2年。主要终点是血栓形成和出血事件的复合终点，次要终点包括心力衰竭住院。在研究登记时，86%的参与者在2017年3月至2019年8月期间接受了直接口服抗凝剂（DOACs），75%接受了基于阿司匹林的三联抗栓治疗（TAT）。阿哌沙班是最常用的DOAC（29%）。虽然抗凝剂的比例未随时间变化，但抗血小板治疗的强度随时间显著降低（基线时双联抗血小板治疗：75%，2年时：7%）。华法林组和DOACs组患者主要结局指标的累积发生率相似。然而，与DOACs相比，华法林组患者心力衰竭住院风险显著更高（风险比：2.8，95%置信区间：1.1-5.8，p = 0.022）。
本研究结果表明，在日本AF合并ACS患者中，通过在研究期间降低抗血小板治疗强度，可适当优化抗栓药物的平衡。
