Antithrombotic strategy variability in atrial fibrillation and obstructive coronary disease revascularised with percutaneous coronary intervention: primary results from the AVIATOR 2 international registry

被引:6
|
作者
Chandrasekhar, Jaya [1 ,2 ]
Baber, Usman [3 ]
Sartori, Samantha [1 ]
Goel, Ridhima [1 ,4 ]
Nicolas, Johny [1 ]
Vogel, Birgit [1 ]
Snyder, Clayton [1 ]
Kini, Annapoorna [1 ]
Briguori, Carlo [5 ]
Witzenbichler, Bernhard [6 ]
Iakovou, Ioannis [7 ]
Sardella, Gennaro [8 ]
Marzo, Kevin [9 ]
DeFranco, Anthony [10 ]
Stuckey, Thomas [11 ]
Chieffo, Alaide [12 ]
Colombo, Antonio [13 ]
Shlofmitz, Richard [14 ]
Capodanno, Davide [15 ]
Dangas, George [1 ]
Pocock, Stuart [16 ]
Mehran, Roxana [1 ,17 ]
机构
[1] Icahn Sch Med Mt Sinai, New York, NY USA
[2] Monash Univ, Box Hill Hosp, Eastern Hlth Clin Sch, Melbourne, Australia
[3] Univ Oklahoma, Hlth Sci Ctr, Oklahoma City, OK USA
[4] SUNY, SUNY Downstate Med Ctr, Brooklyn, NY USA
[5] Mediterranea Cardioctr, Naples, Italy
[6] Helios Amper Klini kum, Dachau, Germany
[7] Onassis Cardiac Surg Ctr, Athens, Greece
[8] Policlin Umberto 1, Rome, Italy
[9] NYU, Langone Hosp Long Isl, Mineola, NY USA
[10] Aurora Hlth Care, Milwaukee, WI USA
[11] Cone Hlth Lebauer HealthCare, Greensboro, NC USA
[12] Osped San Raffaele, Milan, Italy
[13] Humanitas Univ, Dept Biomed Sci, Milan, Italy
[14] St Francis Hosp & Heart Ctr, New York, NY USA
[15] Univ Catania, Ferrarotto Hosp, Catania, Italy
[16] London Sch Hyg & Trop Med, London, England
[17] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, 1 Gustave L Levy Pl,Box 1030, New York, NY 10029 USA
关键词
ACS/NSTE-ACS; atrial fibrillation; stable angina; PREDICTING STROKE; BLEEDING RISK; ANTICOAGULATION; THERAPY; PREVENTION; TRIALS; PCI;
D O I
10.4244/EIJ-D-21-01044
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 CHA2DS2-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 & PLUSMN;9.0 years, including 25.8% females. Triple therapy (TT: 1 anti-coagulant 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.
引用
收藏
页码:E656 / U17
页数:17
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