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Outcome of octogenarians with atrial fibrillation undergoing percutaneous coronary intervention: insights from the AFCAS registry.

Outcome of octogenarians with atrial fibrillation undergoing percutaneous coronary intervention: insights from the AFCAS registry.
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Lahtela HM, Bah A, Kiviniemi T, Nammas W, Schlitt A, Rubboli A, Karjalainen PP, Proietti M, Hartikainen JEK, Lip GYH, Airaksinen KEJ,


Lahtela HM, Bah A, Kiviniemi T, Nammas W, Schlitt A, Rubboli A, Karjalainen PP, Proietti M, Hartikainen JEK, Lip GYH, Airaksinen KEJ, (click to view)

Lahtela HM, Bah A, Kiviniemi T, Nammas W, Schlitt A, Rubboli A, Karjalainen PP, Proietti M, Hartikainen JEK, Lip GYH, Airaksinen KEJ,

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Clinical cardiology 2017 12 15() doi 10.1002/clc.22821
Abstract
BACKGROUND
More evidence is needed on the optimal antithrombotic regimen in elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).

HYPOTHESIS
Octogenarian patients (aged ≥80 years) with AF who underwent PCI have worse 12-month clinical outcome, compared with younger patients.

METHODS
We performed a post-hoc analysis of data from the prospective, multicenter AFCAS registry, which enrolled consecutive patients with AF who underwent PCI and stenting. Outcome measures included major adverse cardiac/cerebrovascular events (MACCE; all-cause death, myocardial infarction, repeat revascularization, stent thrombosis, or stroke/transient ischemic attack) and bleeding events at 12-month follow-up.

RESULTS
Out of 925 AF patients enrolled in AFCAS registry, 195 (21.1%) were ≥80 years. Mean age was 82.9 ± 2.6 years; 41.5% were women; 32.3% had diabetes mellitus. Compared with patients aged <80 years, there were more females among the octogenarians (P < 0.001). Compared with younger patients, octogenarians smoked and had dyslipidemia less often, and presented more frequently with acute coronary syndrome. The frequency and duration of antithrombotic regimens prescribed at discharge were comparable. At 12-month follow-up, overall MACCE rate was higher in octogenarians compared with younger patients (27.7% vs 20.1%, P = 0.02). The rate of acute myocardial infarction was higher in octogenarians (9.2% vs 4.9%, P = 0.02), but the rates of all bleeds and BARC >2 bleeds were similar (P = 0.13, P = 0.29, respectively).

CONCLUSIONS
In real-world patients with AF undergoing PCI, patients aged ≥80 years had higher incidence of MACCE at 12-month follow-up compared with younger patients, although they received comparable antithrombotic treatment. The rates of bleeding events were similar.

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