Park Dae Yong, McLean Bianca, Akman Zafer, Li Darrick K, Babapour Golsa, Nanna Michael G
Section of Cardiovascular Medicine Yale School of Medicine New Haven CT USA.
Department of Medicine Yale School of Medicine New Haven CT USA.
J Am Heart Assoc. 2025 Jun 3;14(11):e038589. doi: 10.1161/JAHA.124.038589. Epub 2025 May 22.
Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) have traditionally received triple therapy (dual antiplatelet therapy and anticoagulation). More recent randomized trial evidence supports a strategy of double therapy (anticoagulant plus single antiplatelet agent), albeit after a brief triple therapy course. The safety of initiating double therapy immediately post-PCI remains unclear.
This study analyzed real-world prescribing patterns and outcomes of immediate double therapy versus initial triple therapy in patients with atrial fibrillation post-PCI using the Vizient Clinical Database. Patients with atrial fibrillation undergoing PCI for myocardial infarction (2016-2023) were categorized into 2 groups: triple therapy (aspirin, P2Y12 [purinergic receptor P2Y, G-protein coupled, 12 protein] inhibitor, and anticoagulant) or double therapy (anticoagulant and 1 antiplatelet agent) on day 1 post-PCI. The primary outcome was in-hospital mortality. Secondary outcomes included stent thrombosis, major bleeding, intracranial hemorrhage, and net clinical adverse events. Multivariable logistic regression and inverse probability of treatment weighting were used to compare outcomes. Among 29 226 patients, 16.3% received immediate double therapy on day 1 post-PCI, whereas 83.7% received triple therapy. Adjusted analyses showed no significant differences in in-hospital mortality (9.4% versus 9.2%, adjusted odds ratio [aOR], 1.05 [95% CI, 0.93-1.18]), major bleeding, intracranial hemorrhage, or net clinical adverse events. However, immediate double therapy was associated with higher odds of stent thrombosis (1.1% versus 0.8%; aOR, 1.48 [95% CI, 1.08-2.03]), particularly in patients with ST-segment-elevation myocardial infarction (2.0% versus 1.3%; aOR, 1.46 [95% CI, 1.001-2.13]).
Immediate double therapy post-PCI is frequently used and appears safe for most patients with atrial fibrillation. Further studies are needed to identify high-risk subgroups, including those with ST-segment-elevation myocardial infarction, who may benefit from an initial short course of triple therapy.
传统上，接受经皮冠状动脉介入治疗（PCI）的房颤患者会接受三联疗法（双重抗血小板治疗和抗凝治疗）。尽管在经过短暂的三联疗法疗程后，最近的随机试验证据支持双重疗法策略（抗凝剂加单一抗血小板药物）。PCI术后立即开始双重疗法的安全性仍不明确。
本研究使用Vizient临床数据库分析了PCI术后房颤患者立即采用双重疗法与初始三联疗法的实际处方模式和结局。因心肌梗死接受PCI治疗的房颤患者（2016 - 2023年）被分为两组：PCI术后第1天接受三联疗法（阿司匹林、P2Y12[嘌呤能受体P2Y，G蛋白偶联，12蛋白]抑制剂和抗凝剂）或双重疗法（抗凝剂和1种抗血小板药物）。主要结局是住院死亡率。次要结局包括支架血栓形成、大出血、颅内出血和净临床不良事件。采用多变量逻辑回归和治疗权重逆概率法比较结局。在29226例患者中，16.3%在PCI术后第1天接受了立即双重疗法，而83.7%接受了三联疗法。校正分析显示，住院死亡率（9.4%对9.2%，校正比值比[aOR]，1.05[95%CI，0.93 - 1.18]）、大出血、颅内出血或净临床不良事件无显著差异。然而，立即双重疗法与较高的支架血栓形成几率相关（1.1%对0.8%；aOR，1.48[95%CI，1.08 - 2.03]），特别是在ST段抬高型心肌梗死患者中（2.0%对1.3%；aOR，1.46[95%CI，1.001 - 2.13]）。
PCI术后立即采用双重疗法在大多数房颤患者中经常使用且似乎是安全的。需要进一步研究以确定高危亚组，包括ST段抬高型心肌梗死患者，他们可能从初始短期三联疗法中获益。
