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Risk Up for Triple Tx Versus DAPT in DES Implantation With A-Fib

TUESDAY, May 23, 2017 -- For patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES), atrial fibrillation (AF) is associated with increased risks, with no benefit and higher risk seen for triple therapy compared to dual antiplatelet therapy (DAPT), according to a study published online May 17 in JACC: Cardiovascular Interventions.

Hyo-In Choi, M.D., from the University of Ulsan College of Medicine in Seoul, South Korea, and colleagues examined data from 10,027 patients who underwent DES implantation and compared the efficacy and safety of dual antiplatelet therapy (DAPT) and triple therapy in patients with AF.

The researchers found that at index PCI, 7.1 percent of patients had a diagnosis of AF. During the six-year follow-up period, the rate of primary outcome (composite of cardiovascular death, myocardial infarction, or stroke) after PCI was significantly higher in patients with versus those without AF (22.1 versus 8.0 percent; P < 0.001). A similar trend was seen for major bleeding (4.5 versus 1.5 percent; P < 0.001). The presence of AF correlated with increased risk of primary outcome (hazard ratio [HR], 2.33; 95 percent confidence interval [CI], 1.95 to 2.79; P < 0.001) and major bleeding (HR, 2.01; 95 percent CI, 1.32 to 3.06; P = 0.001), after multivariable adjustment. The adjusted risk for the primary outcome was similar for the DAPT and triple therapy groups (HR, 1.01; 95 percent CI, 0.60 to 1.69; P = 0.98). Triple therapy was associated with a significantly higher risk of hemorrhagic stroke (HR, 7.73; 95 percent CI, 2.14 to 27.91; P = 0.002) and major bleeding (HR, 4.48; 95 percent CI, 1.81 to 11.08; P = 0.001).

"Among patients receiving DES implantation, AF was not rare and was associated with increased ischemic and bleeding risk," the authors write. "In patients with AF, triple therapy was not associated with decreased ischemic events but was associated with increased bleeding risk compared to DAPT."

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Posted: May 2017