Antithrombotic management of patients with acute coronary syndrome and atrial fibrillation undergoing coronary stenting: a prospective, observational, nationwide study

Abstract

Objective: The aim of the study was to assess current management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) undergoing coronary stenting.

Design: Non-interventional, prospective, nationwide study.

Setting: 76 private or public cardiology centres in Italy.

Participants: Patients with ACS with concomitant AF undergoing percutaneous coronary intervention (PCI).

Primary and secondary outcome measures: To obtain accurate and up-to-date information on pharmacological management of patients with AF admitted for an ACS and undergoing PCI with stent implantation.

Results: Over a 12-month period, 598 consecutive patients were enrolled: 48.8% with AF at hospital admission and 51.2% developing AF during hospitalisation. At discharge, a triple antithrombotic therapy (TAT) was prescribed in 64.8%, dual antiplatelet therapy (DAPT) in 25.7% and dual antithrombotic therapy (DAT) in 8.8% of patients. Among patients with AF at admission, TAT and DAT were more frequently prescribed compared with patients with new-onset AF (76.3% vs 53.8% and 12.5% vs 5.3%, respectively; both p<0.0001), while a DAPT was less often used (11.2% vs 39.5%; p<0.0001). At multivariable analysis, a major bleeding event (OR: 5.40; 95% CI: 2.42 to 12.05; p<0.0001) and malignancy (OR: 5.11; 95% CI: 1.77 to 14.78; p=0.003) resulted the most important independent predictors of DAT prescription.

Conclusions: In this contemporary registry of patients with ACS with AF treated with coronary stents, TAT still resulted as the antithrombotic strategy of choice, DAT was reserved for high bleeding risk and DAPT was mainly prescribed in those developing AF during hospitalisation.

Trial registration number: NCT03656523.

Keywords: adult cardiology; cardiac epidemiology; coronary heart disease; coronary intervention; myocardial infarction.

Conflict of interest statement

Competing interests: LDL and AR received speakers honoraria from Bayer, Boehringer Ingelheim, Daiichi Sankyo, Pfizer/BMS outside the submitted work; All other authors have reported that no potential conflicts of interest exist with any companies/organisations whose products or services may be discussed in this article. LG and DL are employees of ANMCO Research Center, Heart Care Foundation, which conducted the study with an unrestricted grant of research from Boehringer Ingelheim, Pharma GmbH and CoKG.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

In-hospital clinical events. AF, atrial fibrillation; TIA, transient ischaemic attack.

Figure 2

Antithrombotic therapies prescribed at discharge. AF, atrial fibrillation; ASA, acetylsalicylic acid; DOAC, direct oral anticoagulant; VKA, vitamin-K antagonist.

Figure 3

Central illustration. Combination of antithrombotic therapies prescribed at discharge. ACS, acute coronary syndrome; AF, atrial fibrillation; DAPT, dual antiplatelet therapy; DAT, dual antithrombotic therapy; SAPT, single antiplatelet therapy; TAT, triple antithrombotic therapy.

Figure 4

Independent predictors of DAT prescription at multivariable analysis. AF, atrial fibrillation; DAT, dual antithrombotic therapy.