One-year outcomes in anticoagulated atrial fibrillation patients undergoing percutaneous coronary intervention: insights from the Greek Antiplatelet Atrial Fibrillation (GRAPE-AF) registry

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ABSTRACT GReek-AntiPlatElet Atrial Fibrillation (GRAPE-AF) registry is a multicenter, observational, non-interventional study of AF patients undergoing PCI. Primary endpoint included clinically significant bleeding rate at 12 months between different antithrombotic regimens prescribed at discharge; secondary endpoints included major adverse cardiovascular events (MACEs) as well as net adverse clinical events (NACEs). A total of 647 patients were analyzed. The majority (92.9%) were discharged on NOACs with only 7.1% receiving VKA. A little over half of patients (50.4%) received triple antithrombotic therapy (TAT) – mostly (62.9%) for ≤ 1 month – while the rest (49.6%) received dual antithrombotic therapy (DAT). Clinically significant bleeding risk was similar between TAT and DAT (HR = 1.08; 95% CI = 0.66 – 1.78), though among TAT-receiving patients, the risk was lower in those receiving TAT for ≤ 1 month (HR = 0.50; 95% CI = 0.25 – 0.99). Anticoagulant choice (NOAC vs VKA) did not significantly affect bleeding rates (P=0.258). Age, heart failure, leukemia/myelodysplasia and acute coronary syndrome were associated with increased bleeding rates. Risk of MACEs and NACEs was similar between ΤAT and DAT (HR = 1.73; 95% CI = 0.95 – 3.18, P = 0.075 and HR = 1.39; 95% CI = 0.93 – 2.08, P=0.106, respectively). In conclusion, clinically significant bleeding and ischemic rates were similar between DAT and TAT, although TAT >1 month was associated with higher bleeding risk.

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