Outcome of octogenarians with atrial fibrillation undergoing percutaneous coronary intervention: insights from the AFCAS registry
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Published on: February 26, 2013
Heli M Lahtela1, Aissa Bah2, Tuomas Kiviniemi3
1Emergency Department, North-Kymi Hospital, Kouvola, Finland.
Insights
Elderly patients (≥80 years) with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) experienced more major adverse cardiac/cerebrovascular events (MACCE) but similar bleeding rates. Antithrombotic treatment was comparable between age groups.
Area of Science:
- Cardiology
- Geriatrics
- Interventional Cardiology
Background:
- Optimal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) requires further investigation.
- Elderly patients (≥80 years) with AF undergoing PCI face worse clinical outcomes.
Purpose of the Study:
- To compare 12-month clinical outcomes in octogenarian patients (≥80 years) versus younger patients with AF who underwent PCI.
- To analyze the incidence of major adverse cardiac/cerebrovascular events (MACCE) and bleeding in elderly AF patients post-PCI.
Main Methods:
- Post-hoc analysis of the prospective, multicenter AFCAS registry.
- Inclusion of consecutive patients with AF undergoing PCI and stenting.
- Assessment of MACCE (all-cause death, myocardial infarction, repeat revascularization, stent thrombosis, stroke/transient ischemic attack) and bleeding events at 12-month follow-up.
Main Results:
- Octogenarians (195/925 patients) had a higher MACCE rate (27.7% vs. 20.1%, P=0.02) and acute myocardial infarction rate (9.2% vs. 4.9%, P=0.02) at 12 months.
- Bleeding event rates (all bleeds and BARC >2 bleeds) were similar between octogenarians and younger patients.
- Antithrombotic regimens at discharge were comparable across age groups.
Conclusions:
- Octogenarian patients with AF undergoing PCI experience significantly higher rates of MACCE compared to younger patients.
- Despite comparable antithrombotic treatment, elderly AF patients post-PCI face increased adverse events without a corresponding rise in bleeding.
- Real-world data suggest a need to re-evaluate antithrombotic strategies for octogenarians with AF undergoing PCI.
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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