SPC365

Antithrombotic strategy in patients with atrial fibrillation and acute coronary syndrome

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Inês Grácio Almeida

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Posters
FP Number: ---
Authors: Inês Grácio De Almeida; Hélder Santos; Mariana Santos; Hugo Miranda; Joana Chin; Catarina sá; Samuel Almeida; Catarina Sousa; Lurdes Almeida; Registo Nacional de Síndromes Coronárias Agudas

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Atrial fibrillation (AF) is frequent in patients admitted with </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">acute coronary syndromes (ACS). The development of this arrhythmia occurs in 2&ndash;21% of patients with non ST-elevation ACS and 21% of ST-elevation ACS.<strong> </strong>According with the most recent European guidelines, a short period up to 1 week of triple antithrombotic therapy (TAT) is recommended, followed by dual antithrombotic therapy (DAT) using a NOAC and a single antiplatelet agent, preferably clopidogrel.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Objective:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> To compare the&nbsp;antithrombotic strategy (DAT vs TAT) used and its prognostic value&nbsp;in patients with AF and ACS. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Retrospective analysis of patients&acute; data admitted with ACS in a multicentric registry between 10/2010 - 09/2019. TAT was defined as the prescription of dual antiplatelet therapy and one anticoagulant and DAT as one antiplatelet and one anticoagulant. Survival and rehospitalization were evaluated through Kaplan-Meier curve.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> 1067 patients were included, mean age 67</span></span><span style="font-size:12.0pt">&plusmn;</span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">14 years, 72.3% male. Patients who developed <em>de novo</em> AF during hospitalization due to ACS were older (75</span></span><span style="font-size:12.0pt">&plusmn;</span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">12 vs 66</span></span><span style="font-size:12.0pt">&plusmn;</span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">14 years, p&lt;0.001) and with higher prevalence of cardiovascular risk factors and cardiovascular disease. &nbsp;AF was more often in patients with ST elevation ACS (53.4%). During hospitalization, AF patients were more often medicated with aspirin, glycoprotein inhibitor, heparin, fondaparinux and vitamin K antagonists. No difference was found regarding P2Y12 inhibitors. AF patients presented more often obstructive coronary disease (normal coronaries 5.4 vs 8.5%, p&lt;0.001) so they were more often submitted to PCI (79.5 vs 70.9%, p&lt;0.001). AF patients presented with higher rates of adverse in-hospital events as re-infarction, heart failure, shock, ventricular arrhythmias, cardiac arrest, stroke, major bleeding and death (p&lt;0.001). At discharge, AF patients were less prescribed with aspirin or ticagrelor, but the rate of clopidogrel prescription was higher, such as vitamin K antagonists or any of the new anticoagulants. In the AF group, 21.5% patients were discharged with TAT and 30.3% with DAT. Concerning patients discharged with TAT, 1-year follow-up revealed no significant differences in mortality (p=0.578), re-admission for cardiovascular causes (p=0.301) and total re-admission rates (p=0.291). Patients discharged with DAT had similar mortality (p=0.623) and re-admission for cardiovascular causes rates (p=0.138), but significant differences were identified regarding total re-admissions (p=0.024).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> In patients with ACS and <em>de novo</em> AF, a low percentage of patients was discharged with oral anticoagulation (51.8%). In those whose anticoagulation was initiated, DAT was the preferred strategy. 1-year outcomes were not different between the antithrombotic strategy, except for all cause re-admission. </span></span></span></span></p>