Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents: PACO-PCI (EPIC-15) registry

Destacados, iEpic
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Autores:  Jose M de la Torre Hernandez, José Luis Ferreiro, Ramon Lopez-Palop, Soledad Ojeda, David Marti, Pablo Avanzas, Jose A Linares, Alejandro Diego, Ignacio J Amat, Miren Telleria, Belen Cid, Imanol Otaegui, Iñigo Lozano, David Serrano, Eduardo Pinar, Rafael González Manzanares, Ricardo Concepción Suárez, Isaac Pascual, Cristobal Urbano, Mario Sadaba, Marcos Garcia-Guimaraes, Joan F Andres-Cordon, Felipe Hernandez, Angel Sanchez Recalde, Celia Garilleti, Armando Perez de Prado.

RATIONALE

The aim of the present study was to explore contemporary patterns of antithrombotic therapy in elderly (>75 years) patients with AF undergoing PCI with drug-eluting stents (DES) as well as to evaluate the effectiveness and safety of the different antithrombotic strategies employed in real-world clinical practice in this high-risk scenario.

METHODS

The PACO-PCI is a retrospective, multicenter registry that consecutively included patients over 75 years of age who underwent PCI with DES, and had indication of chronic OAC for atrial fibrillation in the period 2016-2019. Antithrombotic treatment was decided by the cardiologist in charge of the patient, as per local practices. Inclusion criteria: A) Age over 75 years. B) Presence of atrial fibrillation with indication for chronic OAC. C) Undergoing PCI with implantation of at least one DES. D) Treatment with combined antiplatelet and anticoagulant drugs (VKA or DOAC) at discharge after PCI.

Two primary endpoints were considered:
1- A primary endpoint of MACCE (major adverse cardiovascular and cerebrovascular events) consisting on the combination of cardiovascular death, myocardial infarction, stroke and systemic vascular embolism at 12 months after PCI.
2- A primary endpoint of major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria, [14] at 12 months after PCI.

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