1. Is percutaneous coronary intervention safe during uninterrupted direct oral anticoagulant therapy in patients with atrial fibrillation and acute coronary syndromes?
- Author
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De Luca L, Rubboli A, Bolognese L, Uguccioni M, Lucci D, Blengino S, Campodonico J, Meynet I, Brach Prever SM, Di Lenarda A, Gabrielli D, and Gulizia MM
- Subjects
- Acute Coronary Syndrome complications, Administration, Oral, Aged, Atrial Fibrillation complications, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Male, Prospective Studies, Survival Rate trends, Acute Coronary Syndrome surgery, Anticoagulants administration & dosage, Atrial Fibrillation drug therapy, Drug-Eluting Stents, Percutaneous Coronary Intervention methods, Postoperative Complications epidemiology, Registries, Risk Assessment methods
- Abstract
Objectives: No data on optimal management of patients with acute coronary syndromes (ACS) on long-term direct oral anticoagulants (DOACs) undergoing percutaneous coronary intervention (PCI) are available. Using the data of the Management of Antithrombotic TherApy in Patients with Chronic or DevelOping AtRial Fibrillation During Hospitalization for PCI study, we sought to compare the outcome of patients with ACS and atrial fibrillation (AF) who underwent PCI during uninterrupted DOAC (UDOAC group) and those who interrupted DOAC before PCI (IDOAC group)., Methods: The primary outcomes of our analysis were the incidence of major adverse cardiovascular events (MACEs), a composite of death, cerebrovascular events, recurrent myocardial infarction or revascularisation and net adverse clinical events (NACEs), including major bleeding, at 6 months., Results: Among the 132 patients on long-term DOAC, 72 (54.6%) underwent PCI during UDOAC and 60 (45.4%) after IDOAC. The mean CHA
2 DS2 -VASc score was 3.8±1.7 and 3.9±1.3 (p=0.89), while the HAS-BLED score was 2.5±1.0 and 2.5±0.9 (p=0.96), in UDOAC and IDOAC groups, respectively. The median time from hospital admission to PCI was 9.5 (IQR: 2.0-31.5) hours in UDOAC and 45.5 (IQR: 22-5-92.0) hours in IDOAC group (p<0.0001). A radial approach was used in 92%, and a drug-eluting stent was implanted in 98% of patients. At 6 months, the rates of MACE (13.9% vs 16.7%) and NACE (20.8% vs 21.7%) did not differ between UDOAC and IDOAC groups. At multivariable analysis, increasing CHA2 DS2 -VASc score (HR: 1.39; 95% CIs 1.05 to 1.83; p=0.02) resulted as the only independent predictor of NACE., Conclusions: Our study shows that PCI is a safe procedure during UDOAC in patients with concomitant ACS and AF., Competing Interests: Competing interests: LDL and AR report lecture fees from Bayer, Boehringer Ingelheim, Daiichi Sankyo and 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. DL is an employee of Heart Care Foundation, which conducted the study with an unrestricted grant of research from Boehringer Ingelheim and Pharma GmbH & CoKG., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2021
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