Antithrombotic strategy variability in atrial fibrillation and obstructive coronary disease revascularised with percutaneous coronary intervention: Primary results from the AVIATOR 2 international registry

Jaya Chandrasekhar, Icahn School of Medicine at Mount Sinai, New York, NY, USA.Follow
Usman Baber, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.Follow
Samantha Sartori, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ridhima Goel, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Johny Nicolas, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Birgit Vogel, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Clayton Snyder, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Annapoorna Kini, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Carlo Briguori, Mediterranea Cardiocentro, Naples, Italy.
Bernhard Witzenbichler, Helios Amper-Klinikum, Dachau, Germany.
Ioannis Iakovou, Onassis Cardiac Surgery Center, Athens, Greece.
Gennaro Sardella, Policlinico Umberto I, Rome, Italy.
Kevin Marzo, NYU Langone Hospital-Long Island, Mineola, NY, USA.
Anthony DeFranco, Advocate Aurora HealthFollow
Thomas Stuckey, Cone Health Lebauer HealthCare, Greensboro, NC, USA.
Alaide Chieffo, San Raffaele Hospital, Milan, Italy.
Antonio Colombo, Department of Biomedical Sciences, Humanitas University, Milan, Italy and IRCCS Humanitas Research Hospital, Italy.Follow
Richard Shlofmitz, Saint Francis Hospital and Heart Center, New York, NY, USA.
Davide Capodanno, Ferrarotto Hospital, University of Catania, Catania, Italy.
George Dangas, Icahn School of Medicine at Mount Sinai, New York, NY, USA.Follow
Stuart Pocock, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Roxana Mehran, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abstract

Background: Managing percutaneous coronary intervention (PCI) patients with atrial fibrillation (AF) presents challenges given that there are several potential antithrombotic therapy (ATT) strategies.

Aims: We examined ATT patterns, agreement between subjective physician ratings and validated risk scores, physician-patient perceptions influencing ATT and 1-year outcomes.

Methods: The AVIATOR 2 prospective registry enrolled 514 non-valvular AF-PCI patients from 11 sites. Treating physicians selected ATT and completed smartphone surveys rating stroke and bleeding risks, compared against CHA2DS2-VASc and HAS-BLED scores. Patients completed surveys regarding treatment understanding. Primary outcomes were 1-year major adverse cardiac or cerebrovascular events (MACCE: composite of death, myocardial infarction, definite/probable stent thrombosis, stroke, target lesion revascularisation) and actionable bleeding (Bleeding Academic Research Consortium 2, 3 or 5).

Results: The mean patient age was 73.2±9.0 years, including 25.8% females. Triple therapy (TT: 1 anticoagulant and 2 antiplatelet agents) was prescribed in 66.5%, dual antiplatelet therapy (DAPT) in 20.7% and dual therapy (1 anticoagulant+1 antiplatelet agent) in 12.8% of patients. Physician ratings and validated risk scores showed poor agreement (stroke: kappa=0.03; bleeding: kappa=0.07). Physicians rated bleeding-related safety (93.8%) as the main factor affecting ATT choice. Patients worried about stroke over bleeding (50.6% vs 14.8%). No group differences by ATT strategy were observed in 1-year MACCE (TT 14.1% vs dual therapy 12.7% vs DAPT 18.5%; p=0.25), or actionable bleeding (14.7% vs 7.9% vs 15.1%, respectively; p=0.89).

Conclusions: The AVIATOR 2 study is the first digital health study examining physician-patient perspectives on ATT choices after AF-PCI. TT was the most common strategy without differences in 1-year outcomes in ATT strategy. Physicians rated safety first when prescribing ATT; patients feared stroke over bleeding.

Type

Article

PubMed ID

35656720

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