Triple versus double antithrombotic therapy after PCI in atrial arrhythmia: a real-world comparative analysis based...

The optimal antithrombotic regimen after percutaneous coronary intervention (PCI) in patients with atrial arrhythmias remains uncertain, particularly the balance between double therapy (DT; anticoagulant plus one antiplatelet) and triple therapy (TT; anticoagulant plus dual antiplatelet therapy). Comparative data across coronary artery disease (CAD) phenotypes are limited.

We performed a retrospective cohort study using the TriNetX database, including adults (≥18 years) with atrial fibrillation/flutter undergoing PCI for CAD. Patients receiving TT or DT were matched 1:1 using propensity scores. The primary outcome was a composite of all-cause mortality, ischemic stroke, gastrointestinal bleeding, recurrent myocardial infarction (MI), and repeat PCI. Prespecified subgroup analyses were conducted by CAD phenotype.

After matching, 1,332 patients were included (666 per group). TT was associated with a higher incidence of the composite outcome at 1 month (25.08% vs 17.57%), 6 months (35.74% vs 29.13%), and 12 months (42.79% vs 36.04%). TT was also associated with increased recurrent MI, hospitalization/ER visits, and blood transfusion. In subgroup analyses, outcomes were largely similar in STEMI, whereas TT was associated with higher hospitalization/ER visits in NSTEMI/UA.

Among CAD patients undergoing PCI, TT was associated with worse clinical outcomes than DT, supporting the need for prospective randomized validation.