Background:Patients with atrial fibrillation (AF) treated with percutaneous coronary intervention (PCI) require multiple antithrombotic therapies. The optimal strategy is debated suggesting increased treatment variation. This study sought to characterize site-level variation in antithrombotic therapies in AF patients after PCI and determine the association with outcomes.Methods:Using the retrospective TREAT-AF study (The Retrospective Evaluation and Assessment of Therapies in AF) from the Veterans Health Administration, patients with newly diagnosed, nonvalvular AF between 2004 and 2015 followed by a PCI with a P2Y₁₂-antagonist prescription were identified. Patients were grouped according to the therapy dispensed 7 days before until 30 days after the PCI: oral anticoagulation plus platelet inhibition (OAC+PI) or platelet inhibition only. A combined outcome of death, myocardial infarction, stroke, or major bleeding was assessed 1 year after PCI and Cox regression was performed to estimate hazard ratios.Results:Of 230 762 patients with newly diagnosed AF, 4042 (1.8%) underwent PCI and received a P2Y₁₂-antagonist during the observation period (age, 67±9 years; CHA₂DS₂-VASc, 2.7±1.7; HAS-BLED, 2.6±1.2). Among these, 47% were prescribed OAC+PI, and 53% platelet inhibition only 7 days before until 30 days after the PCI. Across 63 sites, the use of OAC+PI ranged from 19% to 66%. Prescription of OAC+PI was independently associated with a reduction in the combined outcome of death, myocardial infarction, stroke, or major bleeding compared with platelet inhibition only (adjusted hazard ratio, 0.85; 95% CI, 0.73–0.99; P=0.033).Conclusions:In patients with established AF undergoing PCI, the use of OAC+PI varied substantially across sites in the 30 days post-PCI. Anticoagulation appeared to be underutilized but was associated with improved outcomes. Strategies to promote OAC+PI and minimize site variation may be useful, particularly in light of recent randomized trials.

中文翻译：

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经皮冠状动脉介入治疗后房颤患者抗栓治疗的位点变化和结果。

背景：经皮冠状动脉介入治疗（PCI）治疗的房颤（AF）患者需要多种抗血栓治疗。对最佳策略进行了辩论，暗示了治疗差异的增加。这项研究旨在描述PCI后AF患者抗栓治疗中位点水平的变化，并确定其与预后的关系。方法：使用美国退伍军人卫生管理局（Veterans Health Administration）的TREAT-AF回顾性研究（AF的回顾性评估和评估）， 2004年至2015年间新诊断为非瓣膜性心房颤动的患者，然后行P2Y ₁₂ PCI确定了拮抗药处方。根据PCI前7天至30天后分配的治疗方法对患者进行分组：口服抗凝加血小板抑制（OAC + PI）或仅血小板抑制。PCI术后1年评估死亡，心肌梗塞，中风或大出血的综合结果，并进行Cox回归以评估危险比。结果：230 762例新诊断为AF的患者中，有4042例（1.8％）接受了PCI并接受了观察期内的P2Y ₁₂拮抗剂（年龄67±9岁； CHA ₂ DS ₂-VASc，2.7±1.7；HAS-BLED，2.6±1.2）。其中47％的患者开了OAC + PI处方，53％的血小板抑制仅在PCI前7天到术后30天服用。在63个站点中，OAC + PI的使用率为19％至66％。与仅使用血小板抑制相比，OAC + PI的处方与死亡，心肌梗塞，中风或大出血的合并预后的减少有独立的相关性（调整后的危险比，0.85； 95％CI，0.73-0.99；P = 0.033）结论：在已建立房颤并接受PCI的患者中，PCI后30天内OAC + PI的使用在各个部位之间有很大差异。抗凝药似乎未得到充分利用，但与转归改善有关。促进OAC + PI和最小化位点变异的策略可能会有用，尤其是根据最近的随机试验。