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TCT-224 Real world use of antithrombotic regimens after percutaneous coronary intervention in patients with atrial fibrillation
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
population as well as in non-CKD one. But long-term DAPT may increase the incidence of TIMI major bleeding, which reached statistical significance in the larger non-CKD population while did not in the smaller CKD one. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-223 A randomized, placebo controlled, double-blind, phase 4 study to evaluate efficacy and safety of triple anti-platelet therapy compared with dual antiplatelet therapy in patients treated with drug-eluting stent for coronary artery disease Cheol Hyun Lee,1 Osung Kwon,2 Ungjeong Do,3 Jung Ae Hong,4 Kyusup Lee,5 Min Soo Cho,6 Jaeseok Bae,7 Do-yoon Kang,8 Se Hun Kang,9 Pil Hyung Lee,10 Sung-Han Yoon,11 Jung-Min Ahn,12 Duk-Woo Park,13 Soo-Jin Kang,14 Seung-Whan Lee,15 Young-Hak Kim,16 Cheol Whan Lee,17 Seong-Wook Park,18 Seung-Jung Park19 1 Asan medical center, seoul, Korea, Republic of; 2Asan Medical Center, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Asan Medical Center, Seoul, Korea, Republic of; 5 AMC, Seoul, Korea, Republic of; 6Asan medical center, Seoul, Korea, Republic of; 7Asan medical center, Seoul, Korea, Republic of; 8Asan Medical Center, Seoul, Korea, Republic of; 9Asan Medical Center, Seoul, Korea, Republic of; 10Columbia University Medical Center, Seoul, Korea, Republic of; 11Asan Medical Center, Seoul, Korea, Republic of; 12 Asan Medical Center, Seoul, Korea, Republic of; 13Asan Medical Center, Seoul, Korea, Republic of; 14Asan Medical Center, Seoul, Korea, Republic of; 15Asan Medical Center, Seoul, Korea, Republic of; 16Asan Medical Center, Seoul, Korea, Republic of; 17Asan Medical Center, Seoul, Korea, Republic of; 18Asan Medical Center, Seoul, Korea, Republic of; 19Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Although drug-eluting stent (DES) implantation significantly reduced the restenosis, restenosis after DES implantation remains a significant clinical problem. Previous study showed that triple antiplatelet, with aspirin, clopidogrel, and cilostazol, significantly reduced stent thrombosis and myocardial infarction after DES implantation in a broad range of population. This study evaluate efficacy and safety of triple anti-platelet therapy compared with dual antiplatelet therapy in patients treated with DES for coronary artery disease. METHODS This prospective, double-blind, multicenter, randomized, phase 4 study was conducted in 9 cardiac centers in Korea between September 2011 and January 2014. Patients (n ¼ 404) were randomly assigned to triple (aspirin, clopidogrel, and cilostazol, triple group: n ¼ 202) or dual antiplatelet therapy (aspirin and clopidogrel and placebo, dual group: n ¼ 202). Primary endpoint was composite of any death, myocardial infarction (MI), ischemic stroke, or target vessel revascularization (major adverse cardiac and cerebrovascular event, MACCE) for 12 months. RESULTS The two groups had similar about In addition, target vessel revascularization (0.9% vs 5.1%, p ¼ 0.015) and target lesion revascularization rate (0.9% vs 4.6%, p ¼ 0.025) of triple group were significantly lower than those of dual group. There was no difference in safety outcome between two groups.
B91
CONCLUSION Triple antiplatelet therapy after DES implantation tends to improve clinical outcome through reduction of target vessel revascularization. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-224 Real world use of antithrombotic regimens after percutaneous coronary intervention in patients with atrial fibrillation Michela Faggioni,1 Jaya Chandrasekhar,2 Melissa Aquino,3 Birgit Vogel,4 Usman Baber,5 Samin Sharma,6 Annapoorna Kini,7 Serdar Farhan,8 Jason Kovacic,9 Prakash Krishnan,10 Pedro Moreno,11 George Dangas,12 Roxana Mehran13 1 Mount Sinai Medical Center, New York, New York, United States; 2 Mount Sinai Hospital, New York, New York, United States; 3Mount Sinai Medical Center; 4Icahn School of Medicine at Mount Sinai, New York, New York, United States; 5Mount Sinai Medical Center, New York, New York, United States; 6The Mount Sinai Medical Center, New York, New York, United States; 7Unknown, New York, New York, United States; 8Icahn School of Medicine at Mount Sinai; 9Mount Sinai Medical Center, New York, New York, United States; 10Mount Sinai Medical Center, New York, New York, United States; 11Mount Sinai Medical Center, New York, New York, United States; 12Mount Sinai Medical Center, New York, New York, United States; 13Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States BACKGROUND The optimal antithrombotic regimen after PCI for patients with atrial fibrillation(AF) is unclear. Availability of direct oral anticoagulants (DOAC) might change the treatment strategy for these patients. We investigated the use of antithrombotic regimens with warfarin and DOAC in a real world PCI population. METHODS We analyzed data from 1269 patients with history of AF treated with PCI at a tertiary care Hospital in New York City from 2010 to 2015. Therapies were defined as: Dual antiplatelet therapy (DAPT); Dual¼ASA or P2Y12 inhibitor + warfarin (Warf) or DOAC; triple¼ DAPT + Warf or DOAC. RESULTS The prescription of DAPT, dual and triple at discharge is in Fig.A. Overall for both dual and triple, the use of Warf and DOAC was 65% and 35% respectively. However there was a progressive increase in the use of DOAC over time Fig. B. Patients prescribed DOAC had lower baseline eGFR and CHADS2 thromboembolic risk score than Warf patients (2.501.12 vs 2.691.13, p¼0.05) but a similar ATRIA bleeding risk score (3.672.14 vs 3.882.23, p¼0.26). The rate of periprocedural complications (4.4%vs3.3%, p¼0.52) and 30-day readmission (5.8%vs5.3%, p¼0.77) did not differ significantly between DOAC and Warf. At 1 year the adjusted risk of all-cause mortality (0.93 [0.48-1.80]) and MACE (death, myocardial infarction or target vessel revascularization)(1.27[0.81-2.01]) were similar between DAOC and Warf.
CONCLUSION Despite the lack of data from large randomized trials the use of DOAC in PCI patients with AF is increasing. DOAC use was not associated with worse short and long term ischemic clinical outcomes compared to Warf. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-225 Cliopidogril And Ticagrelor Highlights on Silent Holter Ambulatory Myocardial Ischemia (CATH SHAMI study) Waleed Kadro,1 Jehad Muhanna,2 Maya Turkmani,3 Ruwaid Rumman,4 malik Zawahrah,5 Hussam Alrahim6 1 Specialized Medical Center, Riyadh, Saudi Arabia; 2Institute of Applied
population as well as in non-CKD one. But long-term DAPT may increase the incidence of TIMI major bleeding, which reached statistical significance in the larger non-CKD population while did not in the smaller CKD one. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-223 A randomized, placebo controlled, double-blind, phase 4 study to evaluate efficacy and safety of triple anti-platelet therapy compared with dual antiplatelet therapy in patients treated with drug-eluting stent for coronary artery disease Cheol Hyun Lee,1 Osung Kwon,2 Ungjeong Do,3 Jung Ae Hong,4 Kyusup Lee,5 Min Soo Cho,6 Jaeseok Bae,7 Do-yoon Kang,8 Se Hun Kang,9 Pil Hyung Lee,10 Sung-Han Yoon,11 Jung-Min Ahn,12 Duk-Woo Park,13 Soo-Jin Kang,14 Seung-Whan Lee,15 Young-Hak Kim,16 Cheol Whan Lee,17 Seong-Wook Park,18 Seung-Jung Park19 1 Asan medical center, seoul, Korea, Republic of; 2Asan Medical Center, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Asan Medical Center, Seoul, Korea, Republic of; 5 AMC, Seoul, Korea, Republic of; 6Asan medical center, Seoul, Korea, Republic of; 7Asan medical center, Seoul, Korea, Republic of; 8Asan Medical Center, Seoul, Korea, Republic of; 9Asan Medical Center, Seoul, Korea, Republic of; 10Columbia University Medical Center, Seoul, Korea, Republic of; 11Asan Medical Center, Seoul, Korea, Republic of; 12 Asan Medical Center, Seoul, Korea, Republic of; 13Asan Medical Center, Seoul, Korea, Republic of; 14Asan Medical Center, Seoul, Korea, Republic of; 15Asan Medical Center, Seoul, Korea, Republic of; 16Asan Medical Center, Seoul, Korea, Republic of; 17Asan Medical Center, Seoul, Korea, Republic of; 18Asan Medical Center, Seoul, Korea, Republic of; 19Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Although drug-eluting stent (DES) implantation significantly reduced the restenosis, restenosis after DES implantation remains a significant clinical problem. Previous study showed that triple antiplatelet, with aspirin, clopidogrel, and cilostazol, significantly reduced stent thrombosis and myocardial infarction after DES implantation in a broad range of population. This study evaluate efficacy and safety of triple anti-platelet therapy compared with dual antiplatelet therapy in patients treated with DES for coronary artery disease. METHODS This prospective, double-blind, multicenter, randomized, phase 4 study was conducted in 9 cardiac centers in Korea between September 2011 and January 2014. Patients (n ¼ 404) were randomly assigned to triple (aspirin, clopidogrel, and cilostazol, triple group: n ¼ 202) or dual antiplatelet therapy (aspirin and clopidogrel and placebo, dual group: n ¼ 202). Primary endpoint was composite of any death, myocardial infarction (MI), ischemic stroke, or target vessel revascularization (major adverse cardiac and cerebrovascular event, MACCE) for 12 months. RESULTS The two groups had similar about In addition, target vessel revascularization (0.9% vs 5.1%, p ¼ 0.015) and target lesion revascularization rate (0.9% vs 4.6%, p ¼ 0.025) of triple group were significantly lower than those of dual group. There was no difference in safety outcome between two groups.
B91
CONCLUSION Triple antiplatelet therapy after DES implantation tends to improve clinical outcome through reduction of target vessel revascularization. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-224 Real world use of antithrombotic regimens after percutaneous coronary intervention in patients with atrial fibrillation Michela Faggioni,1 Jaya Chandrasekhar,2 Melissa Aquino,3 Birgit Vogel,4 Usman Baber,5 Samin Sharma,6 Annapoorna Kini,7 Serdar Farhan,8 Jason Kovacic,9 Prakash Krishnan,10 Pedro Moreno,11 George Dangas,12 Roxana Mehran13 1 Mount Sinai Medical Center, New York, New York, United States; 2 Mount Sinai Hospital, New York, New York, United States; 3Mount Sinai Medical Center; 4Icahn School of Medicine at Mount Sinai, New York, New York, United States; 5Mount Sinai Medical Center, New York, New York, United States; 6The Mount Sinai Medical Center, New York, New York, United States; 7Unknown, New York, New York, United States; 8Icahn School of Medicine at Mount Sinai; 9Mount Sinai Medical Center, New York, New York, United States; 10Mount Sinai Medical Center, New York, New York, United States; 11Mount Sinai Medical Center, New York, New York, United States; 12Mount Sinai Medical Center, New York, New York, United States; 13Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States BACKGROUND The optimal antithrombotic regimen after PCI for patients with atrial fibrillation(AF) is unclear. Availability of direct oral anticoagulants (DOAC) might change the treatment strategy for these patients. We investigated the use of antithrombotic regimens with warfarin and DOAC in a real world PCI population. METHODS We analyzed data from 1269 patients with history of AF treated with PCI at a tertiary care Hospital in New York City from 2010 to 2015. Therapies were defined as: Dual antiplatelet therapy (DAPT); Dual¼ASA or P2Y12 inhibitor + warfarin (Warf) or DOAC; triple¼ DAPT + Warf or DOAC. RESULTS The prescription of DAPT, dual and triple at discharge is in Fig.A. Overall for both dual and triple, the use of Warf and DOAC was 65% and 35% respectively. However there was a progressive increase in the use of DOAC over time Fig. B. Patients prescribed DOAC had lower baseline eGFR and CHADS2 thromboembolic risk score than Warf patients (2.501.12 vs 2.691.13, p¼0.05) but a similar ATRIA bleeding risk score (3.672.14 vs 3.882.23, p¼0.26). The rate of periprocedural complications (4.4%vs3.3%, p¼0.52) and 30-day readmission (5.8%vs5.3%, p¼0.77) did not differ significantly between DOAC and Warf. At 1 year the adjusted risk of all-cause mortality (0.93 [0.48-1.80]) and MACE (death, myocardial infarction or target vessel revascularization)(1.27[0.81-2.01]) were similar between DAOC and Warf.
CONCLUSION Despite the lack of data from large randomized trials the use of DOAC in PCI patients with AF is increasing. DOAC use was not associated with worse short and long term ischemic clinical outcomes compared to Warf. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-225 Cliopidogril And Ticagrelor Highlights on Silent Holter Ambulatory Myocardial Ischemia (CATH SHAMI study) Waleed Kadro,1 Jehad Muhanna,2 Maya Turkmani,3 Ruwaid Rumman,4 malik Zawahrah,5 Hussam Alrahim6 1 Specialized Medical Center, Riyadh, Saudi Arabia; 2Institute of Applied