Coronary disease & ACSSecondary analysis
Antithrombotic Therapy in Patients With Atrial Fibrillation With Prior Complex Percutaneous Coronary Intervention (PCI): A Secondary Analysis of the Randomized ADAPT AF-DES Trial
- post hoc analysis of the randomized ADAPT AF-DES trial
Authors' conclusion
In this post hoc analysis of the randomized ADAPT AF-DES trial, NOAC monotherapy beyond 12 months after PCI was associated with a substantial reduction in bleeding regardless of PCI complexity. Although limited by low absolute event rates, ischemic outcomes did not differ significantly between treatment strategies. These findings suggest that a bleeding-focused long-term antithrombotic strategy may be reasonable in patients with atrial fibrillation and chronic coronary syndrome, including those with prior complex PCI, although prospective validation remains warranted.
Study context
- Population
- Patients with atrial fibrillation ≥12 months after second- or third-generation drug-eluting stent implantation, by PCI complexitycomplex PCI 247 (25.7%) · noncomplex PCI 713 (74.3%)
- Participants
- 960 patients
- Comparison
- NOAC monotherapy vs NOAC plus clopidogrel, according to PCI complexity
- complex PCIn = 247
- noncomplex PCIn = 713
Primary result
Net adverse clinical events, complex PCI group
Hazard ratio
0.42
95% CI 0.21–0.83
P = 0.01
By group
As reported in the abstract
Further findings
| Outcome | NOAC monotherapy | NOAC plus clopidogrel | complex PCI | noncomplex PCI | hazard ratio (95% CI) | P value | |
|---|---|---|---|---|---|---|---|
| Net adverse clinical events, noncomplex PCI group · no significant interaction | 9.6% | 15.7% | Not reported in the abstract | Not reported in the abstract | 0.59 (0.39–0.90) | P = 0.02 | |
| 0.20.5125Hazard ratio (log scale) |
Ischemic outcomes
- Infrequent; did not differ significantly between treatment strategies regardless of PCI complexity
Safety
Bleeding outcomes
- Consistently lower with NOAC monotherapy in both complex and noncomplex PCI groups
Original publication
Summarised from the published abstract; every number is checked against it