Management of Patients Treated With Oral Anticoagulant Therapy Undergoing Percutaneous Coronary Intervention With Stent Implantation: The PERSEO Registry

被引:1
|
作者
Sciahbasi, Alessandro [1 ]
De Rosa, Salvatore [2 ]
Gargiulo, Giuseppe [3 ]
Giacoppo, Daniele [4 ]
Calabro, Paolo [5 ]
Talarico, Giovanni Paolo [6 ]
Zilio, Filippo [7 ]
Talanas, Giuseppe [8 ]
Tebaldi, Matteo [9 ]
Ando, Giuseppe [10 ]
Rigattieri, Stefano [11 ]
Misuraca, Leonardo [12 ]
Cortese, Bernardo [13 ,14 ]
Musuraca, Gerardo [15 ]
Lucci, Valerio [16 ]
Guiducci, Vincenzo [17 ]
Renda, Giulia [18 ]
Zezza, Luigi [19 ]
Versaci, Francesco [20 ]
Giannico, Maria Benedetta [21 ]
Caruso, Marco [22 ]
Fischetti, Dionigi [23 ,29 ]
Colletta, Mauro [24 ]
Santarelli, Andrea [25 ]
Larosa, Claudio [26 ]
Iannone, Alessandro [27 ]
Esposito, Giovanni [3 ]
Tarantini, Giuseppe [28 ]
Musumeci, Giuseppe [29 ]
Rubboli, Andrea [30 ]
机构
[1] Sandro Pertini Hosp, Intervent Cardiol, Rome, Italy
[2] SIMT, Empoli, Italy
[3] Univ Naples Federico II, Dept Adv Biomed Sci, Div Cardiol, Naples, Italy
[4] Univ Catania, Div Cardiol, Azienda Osped Univ Policlin Rodol San Marco, Catania, Italy
[5] AORN St Anna & San Sebastiano, Div Clin Cardiol, Caserta, Italy
[6] Policlin Casilino, Intervent Cardiol, Rome, Italy
[7] Santa Chiara Hosp, Dept Cardiol, Trento, Italy
[8] Sassari Univ Hosp, Clin & Intervent Cardiol, Sassari, Italy
[9] Azienda Osped Univ Ferrara, Cardiovasc Inst, Cona, Italy
[10] Univ Messina, Dept Clin & Expt Med, Cardiol Sect, Messina, Italy
[11] St Andrea Hosp, Intervent Cardiol, Rome, Italy
[12] Misericordia Hosp, Intervent Cardiol Unit, Grosseto, Italy
[13] Fdn Ric & Innovaz Cardiovasc, Milan, Italy
[14] DCB Acad, Milan, Italy
[15] Santa Maria del Carmine Hosp, Empoli, Italy
[16] San Filippo & Nicola Hosp, Intervent Cardiol, Avezzano, Italy
[17] Azienda USL IRCCS Reggio Emilia, Cardiol Unit, Reggio Emilia, Italy
[18] G DAnnunzio Univ Chieti Pescara, Dept Neurosci Imaging & Clin Sci, Chieti Pescara, Italy
[19] Panico Hosp, Empoli, Italy
[20] Santa Maria Goretti Hosp, Div Cardiol, Latina, Italy
[21] SIMT, Empoli, Italy
[22] SIMT, Empoli, Italy
[23] V Fazzi Hosp, Div Cardiol, Lecce, Italy
[24] Maggiore Hosp, Div Cardiol, Bologna, Italy
[25] Bufalini Hosp, Cardiol Unit, Cesena, Italy
[26] Bonomo Hosp, Dept Cardiol, Andria, Italy
[27] Villa Scassi Hosp, Cardiol Div, Genoa, Italy
[28] Univ Padua, Med Sch, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Padua, Italy
[29] Azienda Osped Ordine Mauriziano Torino, Div Cardiol, Empoli, Italy
[30] S Maria delle Croci Hosp, Dept Emergency Internal Med & Cardiol, Div Cardiol, I-48100 Ravenna, Italy
关键词
direct oral anticoagulants; percutaneous coronary intervention; atrial fibrillation; stent; dual antithrombotic therapy; TRIPLE ANTITHROMBOTIC THERAPY; ATRIAL-FIBRILLATION; PROPENSITY SCORE; TRIALS;
D O I
10.1097/FJC.0000000000001607
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In patients on oral anticoagulant (OAC) therapy undergoing percutaneous coronary intervention (PCI) with stent, international guidelines endorse the use of direct oral anticoagulants (DOAC) rather than vitamin K antagonists (VKA) and dual antithrombotic therapy (DAT) rather than triple antithrombotic therapy (TAT). The aim of this study was to evaluate contemporary real-world data on antithrombotic regimens and outcome in patients on OAC undergoing PCI with stent. Consecutive patients on OAC undergoing PCI were enrolled in the multicenter, prospective, observational PERSEO registry (NCT03392948). Primary end point was net adverse clinical events (NACE) with VKA versus DOAC, whereas a secondary prespecified end point was NACE with DAT versus TAT both at 1-year follow-up. From February 2018 to February 2022; in total, 1234 consecutive patients were included. The main indication for OAC was atrial fibrillation (86%), and the mean CHA2DS2VASc and HAS-BLED scores were 4 +/- 2 and 3.6 +/- 1, respectively. Of the 1228 patients discharged alive, 222 (18%) were on VKA and 1006 (82%) on DOAC (P < 0.01). DAT was employed in 197 patients whereas TAT in 1028. At follow-up, NACE rate was significantly higher than VKA compared with DOAC (23% vs. 16%, P = 0.013) and confirmed after propensity score adjustment. TAT and DAT did not differ as regards NACE rate (17% vs. 19%, P = 0.864) although, compared with TAT, DAT was associated with less major bleedings (2% vs. 5%, P= 0.014), confirmed after propensity score adjustment. In conclusion, in patients on OAC undergoing PCI, DOAC, compared with VKA, was associated with a significantly lower occurrence of NACE and DAT reduced bleedings compared with TAT.
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收藏
页码:457 / 467
页数:11
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