0018 : Antithrombotic management in patients with atrial fibrillation undergoing stent implantation: An assessment of the ESC guidelines adherence

Background Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) and stenting initially require triple antithrombotic therapy according to the current ESC 2010 guidelines. The purpose of this study was to assess guidelines adherence and detect predictive factors of the prognosis linked to ESC guidelines adherence and clinical characteristics of this population. Methods AF patients referred for PCI with stenting were enrolled since the year 2011 to 2013. Prescription and chronology of the antithrombotic treatment (AT), occurrence of bleeding, myocardial ischemia, stroke and death were obtained by screening hospitalization reports and phone call with standardized questions during follow-up. Results Among 259 AF patients with PCI and stenting (age 76±10 years; CHA2DS2-VASc score 4.3 ± 1.7), 40% had acute coronary syndrome and 60% had elective PCI. During 633 ± 352 days follow-up, 53/156 (34%) of those admitted for elective PCI were guidelines adherent, whilst they were 10/49 (20%) for non ST elevation myocardial infarction (NSTEMI) and 8/54 (15%) for STEMI. Permanent AF (OR, 0.45; 95%CI 0.23-0.89; p=0.02), history of valvular heart disease (OR 0.51; 95%CI 0.26-0.98; p=0.04), heart failure (OR 0.49; 95%CI 0.25-0.94; p=0.03) and use of OAC before hospitalization (OR 0.48; 95%CI 0.24-0.96; p=0.04) were associated with guidelines adherence. OAC and APT underuse were associated with an increased risk of death (OR 3.73; 95%CI 1.47-10.10, p=0.005 and OR 7.35, 95%CI 2.27-26.68, p=0.0009 respectively) whereas APT overtreatment was associated with a significant lower rate of death (OR 0.23, 95% CI 0.08-0.59, p=0.002). Conclusion Guidelines for antithrombotic therapy in patients with AF who undergo PCI and stent implantation are still poorly followed in clinical practice. OAC underused was associated with an increased risk of death in this population.