Objectives No data on optimal management of patients with acute coronary syndromes (ACS) on long-term direct oral anticoagulants (DOACs) undergoing percutaneous coronary intervention (PCI) are available. Using the data of the Management of Antithrombotic TherApy in Patients with Chronic or DevelOping AtRial Fibrillation During Hospitalization for PCI study, we sought to compare the outcome of patients with ACS and atrial fibrillation (AF) who underwent PCI during uninterrupted DOAC (UDOAC group) and those who interrupted DOAC before PCI (IDOAC group). Methods The primary outcomes of our analysis were the incidence of major adverse cardiovascular events (MACEs), a composite of death, cerebrovascular events, recurrent myocardial infarction or revascularisation and net adverse clinical events (NACEs), including major bleeding, at 6 months. Results Among the 132 patients on long-term DOAC, 72 (54.6%) underwent PCI during UDOAC and 60 (45.4%) after IDOAC. The mean CHA2DS2-VASc score was 3.8±1.7 and 3.9±1.3 (p=0.89), while the HAS-BLED score was 2.5±1.0 and 2.5±0.9 (p=0.96), in UDOAC and IDOAC groups, respectively. The median time from hospital admission to PCI was 9.5 (IQR: 2.0–31.5) hours in UDOAC and 45.5 (IQR: 22-5–92.0) hours in IDOAC group (p<0.0001). A radial approach was used in 92%, and a drug-eluting stent was implanted in 98% of patients. At 6 months, the rates of MACE (13.9% vs 16.7%) and NACE (20.8% vs 21.7%) did not differ between UDOAC and IDOAC groups. At multivariable analysis, increasing CHA2DS2-VASc score (HR: 1.39; 95% CIs 1.05 to 1.83; p=0.02) resulted as the only independent predictor of NACE. Conclusions Our study shows that PCI is a safe procedure during UDOAC in patients with concomitant ACS and AF. Data are available on reasonable request.

中文翻译：

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房颤和急性冠脉综合征患者在不间断直接口服抗凝治疗期间经皮冠状动脉介入治疗是否安全？

目标 没有关于接受经皮冠状动脉介入治疗 (PCI) 的长期直接口服抗凝剂 (DOAC) 的急性冠状动脉综合征 (ACS) 患者最佳管理的数据。使用 PCI 研究住院期间慢性或发育性房颤患者抗血栓治疗管理的数据，我们试图比较在不间断 DOAC 期间接受 PCI 的 ACS 和房颤（AF）患者（UDOAC 组）和那些在 PCI 之前中断 DOAC 的人（IDOAC 组）。方法我们分析的主要结果是主要不良心血管事件 (MACE) 的发生率，包括死亡、脑血管事件、复发性心肌梗死或血运重建和净不良临床事件 (NACE)，包括 6 个月时的大出血。结果 在长期 DOAC 的 132 名患者中，72 名（54.6%）在 UDOAC 期间接受了 PCI，60 名（45.4%）在 IDOAC 之后接受了 PCI。UDOAC 和 IDOAC 组的平均 CHA2DS2-VASc 评分为 3.8±1.7 和 3.9±1.3（p=0.89），而 HAS-BLED 评分分别为 2.5±1.0 和 2.5±0.9（p=0.96）。UDOAC 组从入院到 PCI 的中位时间为 9.5（IQR：2.0-31.5）小时，IDOAC 组为 45.5（IQR：22-5-92.0）小时（p<0.0001）。92% 的患者使用了径向入路，98% 的患者植入了药物洗脱支架。在 6 个月时，UDOAC 和 IDOAC 组的 MACE（13.9% 对 16.7%）和 NACE（20.8% 对 21.7%）的发生率没有差异。在多变量分析中，增加 CHA2DS2-VASc 评分（HR：1.39；95% CIs 1.05 至 1.83；p=0.02）是 NACE 的唯一独立预测因子。结论 我们的研究表明，对于合并有 ACS 和 AF 的患者，在 UDOAC 期间 PCI 是安全的手术。可应合理要求提供数据。