The following is a summary of “Outcomes after TAVI in patients with atrial fibrillation and a history of recent PCI: Results from the ENVISAGE-TAVI AF trial,” published in the January 2024 issue of Cardiology by Moreno et al.

Patients with atrial fibrillation (AF) and recent (≤ 90 days) percutaneous coronary intervention (PCI) undergoing TAVI are at high bleeding risk due to dual antiplatelet therapy on top of oral anticoagulants.

Researchers conducted a retrospective study to collect patient outcome data for optimizing antithrombotic treatment strategies.

They analyzed annualized clinical event rates in patients who had undergone recent PCI and those who hadn’t within the ENVISAGE-TAVI AF trial. This prospective, randomized, open-label study compared edoxaban and vitamin K antagonists in AF patients following TAVI. The primary endpoints assessed were net adverse clinical events (NACE) and major bleeding, with outcomes adjudicated blinded.

The results showed that among 132 (94.3%) patients who underwent recent PCI (n=140) received OAP after TAVI, whereas among those without recent PCI (n=1237), 692 (55.9%) received OAP. In patients with recent PCI on OAP agents, dual antiplatelet therapy decreased to 5.5%, while single antiplatelet therapy (SAPT) increased to 78.0% over 3 months post-randomization. Conversely, SAPT was predominant at all time points in patients without recent PCI history. There were no significant differences in the incidence of NACE or other outcomes assessed, except for major bleeding events, which were more frequent in patients with recent PCI compared to those without (HR [95% CI]: 2.17 [1.27, 3.73]; P=0.005).

Investigators concluded that TAVI in AF patients with recent PCI carries similar ischemic risk but higher bleeding risk compared to those without recent PCI.

Source: link.springer.com/article/10.1007/s00392-024-02379-5