Antithrombotic strategy variability in atrial fibrillation and obstructive coronary disease revascularised with percutaneous coronary intervention: primary results from the AVIATOR 2 international registry.
| Autor: | Chandrasekhar J; Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Box Hill Hospital, Eastern Health Clinical School and Monash University, Melbourne, Australia., Baber U; University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA., Sartori S; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Goel R; Icahn School of Medicine at Mount Sinai, New York, NY, USA.; State University of New York, SUNY Downstate Medical Center, Brooklyn, NY, USA., Nicolas J; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Vogel B; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Snyder C; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Kini A; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Briguori C; Mediterranea Cardiocentro, Naples, Italy., Witzenbichler B; Helios Amper-Klinikum, Dachau, Germany., Iakovou I; Onassis Cardiac Surgery Center, Athens, Greece., Sardella G; Policlinico Umberto I, Rome, Italy., Marzo K; NYU Langone Hospital-Long Island, Mineola, NY, USA., DeFranco A; Aurora Health Care, Milwaukee, WI, USA., Stuckey T; Cone Health Lebauer HealthCare, Greensboro, NC, USA., Chieffo A; San Raffaele Hospital, Milan, Italy., Colombo A; Department of Biomedical Sciences, Humanitas University, Milan, Italy and IRCCS Humanitas Research Hospital, Italy., Shlofmitz R; Saint Francis Hospital and Heart Center, New York, NY, USA., Capodanno D; Ferrarotto Hospital, University of Catania, Catania, Italy., Dangas G; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Pocock S; London School of Hygiene and Tropical Medicine, London, United Kingdom., Mehran R; Icahn School of Medicine at Mount Sinai, New York, NY, USA. |
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| Jazyk: | angličtina |
| Zdroj: | EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology [EuroIntervention] 2022 Oct 07; Vol. 18 (8), pp. e656-e665. Date of Electronic Publication: 2022 Oct 07. |
| DOI: | 10.4244/EIJ-D-21-01044 |
| Abstrakt: | 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 CHA Results: The mean patient age was 73.2±9.0 years, including 25.8% females. Triple therapy (TT: 1 anticoagulant 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. Clinicaltrials: gov: NCT02362659. |
| Databáze: | MEDLINE |
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