Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study

CONNECT AF+PCI Study Investigators

doi:10.1016/j.cjco.2021.07.003

Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study

CONNECT AF+PCI Study Investigators

Medicine

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. Results: The median (25th, 75th percentile) CHADS₂ score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). Conclusions: Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention.

Original language	English
Pages (from-to)	1419-1427
Number of pages	9
Journal	CJC Open
Volume	3
Issue number	12
DOIs	https://doi.org/10.1016/j.cjco.2021.07.003
Publication status	Published - Dec 2021

Bibliographical note

Funding Information:
The CONNECT AF+PCI study was supported by the Canadian Heart Research Centre (CHRC) through an unrestricted investigator-initiated grant from Bayer Inc. The sponsors had no involvement in the collection, analysis, or interpretation of the data; in the writing of the article; or in the decision to submit the article for publication.

Funding Information:
S.G.G. has received research grant support (eg, steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (eg, advisory boards) from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi-Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, GlaxoSmithKline, HLS Therapeutics, Janssen/Johnson & Johnson, Merck, Novartis, Novo Nordisk A/C, Pendopharm, Pfizer, Regeneron, Sanofi, and Servier; and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, and PERFUSE Research Institute. A.H. has received speaking honoraria from Bayer, Bristol Myers Squibb/Pfizer, and Servier. S.M. has received unrestricted research grants from AstraZeneca, Abbott Vascular, and Opsens; and speaker or advisory honoraria from AstraZeneca, Pfizer, Bristol Myers Squibb, Sanofi, Amgen, Boehringer Ingelheim, Bayer, Soundbite, Servier, Gilead, Abbott Vascular, and Novartis. R.C.W. has received research grant support and/or speaking/consulting honoraria from AstraZeneca, Boehringer Ingelheim, Bayer, and Pfizer. A.T.Y. has received research grant support from AstraZeneca. Stephane Rinfret has received consulting honoraria from Boston Scientific, Teleflex, Abbott Vascular, and Terumo. B.J.P. has received research grant support and/or speaker/consulting honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Edwards Lifescience, Novartis, Pfizer, and Servier. M.K.N. has received consulting/speaking honoraria from AstraZeneca, Bayer, Bristol Myers Squibb/Pfizer, Boston Scientific, and Edwards Canada. B.D. has received consulting fees/honoraria from Bayer, Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, and AstraZeneca. B.H. has received speaking honoraria from Abbott, AstraZeneca, Bayer, Bristol Myers Squibb, and Novartis. J.G. has received consulting and/or speaking honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, HLS Therapeutics, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, Sanofi, and Servier. J.-F.T. has received research grant support and/or consulting speaking honoraria from Abbott, Abbott Vascular, AstraZeneca, Bayer, Biosensors, Bristol-Myers Squibb/Pfizer Alliance, Daiichi-Sankyo, Idorsia, Novartis, and Servier. J.-P.D. has received speaker and consulting honoraria from Astra Zeneca, Bayer, Bristol-Myers Squibb /Pfizer, Boehringer Ingelheim, Servier, Sanofi, Amgen, and HLS Therapeutics. M.M. has served on the advisory board of Bayer Inc., Canada, and Sanofi Canada, and as site principal investigator on the RE-DUAL PCI study. B.E. has received speaking honoraria from Bayer. D.Y.F.S. has received unrestricted grant support (physician-initiated grant) from Eli Lilly Canada, Spartan Biosciences, Aggredyne, and Diapharma/Roche Diagnostics; has been a member of the advisory board and received honoraria from AstraZeneca Canada; has been a member of the advisory board for Bayer Canada; and has received honoraria from Abbott Vascular, Canada, and Servier Canada. A.B. has received consulting/speaking honoraria from Astra Zeneca, Bayer Inc., Bristol-Myers Squibb/Pfizer, Servier, Boehringer Ingelheim, HLS Therapeutics, and Abbott Vascular. The other authors have no conflicts of interest to disclose.

Publisher Copyright:
© 2021 The Authors

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

PubMed: MeSH publication types

Journal Article

Access to Document

10.1016/j.cjco.2021.07.003

Cite this

@article{f9760afe9ac24963bf377d372fa5a50f,

title = "Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study",

abstract = "Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. Results: The median (25th, 75th percentile) CHADS2 score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). Conclusions: Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention.",

author = "{CONNECT AF+PCI Study Investigators} and Valle, {Felipe H.} and Goodman, {Shaun G.} and Mary Tan and Andrew Ha and Samer Mansour and Welsh, {Robert C.} and Yan, {Andrew T.} and Bainey, {Kevin R.} and Stephane Rinfret and Potter, {Brian J.} and Razi Khan and Gerald Simkus and Natarajan, {Madhu K.} and Schwalm, {J. D.} and Benoit Daneault and Eisenberg, {Mark J.} and Joseph Abunassar and Bryan Har and Jean Gregoire and Tanguay, {Jean Francois} and Overgaard, {Christopher B.} and Dery, {Jean Pierre} and {De Larochelliere}, Robert and Paradis, {Jean Michel} and Mina Madan and Basem Elbarouni and So, {Derek Y.F.} and Quraishi, {Ata Ur Rehman} and Akshay Bagai",

note = "Funding Information: The CONNECT AF+PCI study was supported by the Canadian Heart Research Centre (CHRC) through an unrestricted investigator-initiated grant from Bayer Inc. The sponsors had no involvement in the collection, analysis, or interpretation of the data; in the writing of the article; or in the decision to submit the article for publication. Funding Information: S.G.G. has received research grant support (eg, steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (eg, advisory boards) from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi-Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, GlaxoSmithKline, HLS Therapeutics, Janssen/Johnson & Johnson, Merck, Novartis, Novo Nordisk A/C, Pendopharm, Pfizer, Regeneron, Sanofi, and Servier; and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, and PERFUSE Research Institute. A.H. has received speaking honoraria from Bayer, Bristol Myers Squibb/Pfizer, and Servier. S.M. has received unrestricted research grants from AstraZeneca, Abbott Vascular, and Opsens; and speaker or advisory honoraria from AstraZeneca, Pfizer, Bristol Myers Squibb, Sanofi, Amgen, Boehringer Ingelheim, Bayer, Soundbite, Servier, Gilead, Abbott Vascular, and Novartis. R.C.W. has received research grant support and/or speaking/consulting honoraria from AstraZeneca, Boehringer Ingelheim, Bayer, and Pfizer. A.T.Y. has received research grant support from AstraZeneca. Stephane Rinfret has received consulting honoraria from Boston Scientific, Teleflex, Abbott Vascular, and Terumo. B.J.P. has received research grant support and/or speaker/consulting honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Edwards Lifescience, Novartis, Pfizer, and Servier. M.K.N. has received consulting/speaking honoraria from AstraZeneca, Bayer, Bristol Myers Squibb/Pfizer, Boston Scientific, and Edwards Canada. B.D. has received consulting fees/honoraria from Bayer, Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, and AstraZeneca. B.H. has received speaking honoraria from Abbott, AstraZeneca, Bayer, Bristol Myers Squibb, and Novartis. J.G. has received consulting and/or speaking honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, HLS Therapeutics, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, Sanofi, and Servier. J.-F.T. has received research grant support and/or consulting speaking honoraria from Abbott, Abbott Vascular, AstraZeneca, Bayer, Biosensors, Bristol-Myers Squibb/Pfizer Alliance, Daiichi-Sankyo, Idorsia, Novartis, and Servier. J.-P.D. has received speaker and consulting honoraria from Astra Zeneca, Bayer, Bristol-Myers Squibb /Pfizer, Boehringer Ingelheim, Servier, Sanofi, Amgen, and HLS Therapeutics. M.M. has served on the advisory board of Bayer Inc., Canada, and Sanofi Canada, and as site principal investigator on the RE-DUAL PCI study. B.E. has received speaking honoraria from Bayer. D.Y.F.S. has received unrestricted grant support (physician-initiated grant) from Eli Lilly Canada, Spartan Biosciences, Aggredyne, and Diapharma/Roche Diagnostics; has been a member of the advisory board and received honoraria from AstraZeneca Canada; has been a member of the advisory board for Bayer Canada; and has received honoraria from Abbott Vascular, Canada, and Servier Canada. A.B. has received consulting/speaking honoraria from Astra Zeneca, Bayer Inc., Bristol-Myers Squibb/Pfizer, Servier, Boehringer Ingelheim, HLS Therapeutics, and Abbott Vascular. The other authors have no conflicts of interest to disclose. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = dec,

doi = "10.1016/j.cjco.2021.07.003",

language = "English",

volume = "3",

pages = "1419--1427",

journal = "CJC Open",

issn = "2589-790X",

publisher = "Elsevier Inc.",

number = "12",

}

TY - JOUR

T1 - Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation

T2 - Findings From the CONNECT AF+PCI Study

AU - CONNECT AF+PCI Study Investigators

AU - Valle, Felipe H.

AU - Goodman, Shaun G.

AU - Tan, Mary

AU - Ha, Andrew

AU - Mansour, Samer

AU - Welsh, Robert C.

AU - Yan, Andrew T.

AU - Bainey, Kevin R.

AU - Rinfret, Stephane

AU - Potter, Brian J.

AU - Khan, Razi

AU - Simkus, Gerald

AU - Natarajan, Madhu K.

AU - Schwalm, J. D.

AU - Daneault, Benoit

AU - Eisenberg, Mark J.

AU - Abunassar, Joseph

AU - Har, Bryan

AU - Gregoire, Jean

AU - Tanguay, Jean Francois

AU - Overgaard, Christopher B.

AU - Dery, Jean Pierre

AU - De Larochelliere, Robert

AU - Paradis, Jean Michel

AU - Madan, Mina

AU - Elbarouni, Basem

AU - So, Derek Y.F.

AU - Quraishi, Ata Ur Rehman

AU - Bagai, Akshay

N1 - Funding Information: The CONNECT AF+PCI study was supported by the Canadian Heart Research Centre (CHRC) through an unrestricted investigator-initiated grant from Bayer Inc. The sponsors had no involvement in the collection, analysis, or interpretation of the data; in the writing of the article; or in the decision to submit the article for publication. Funding Information: S.G.G. has received research grant support (eg, steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (eg, advisory boards) from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi-Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, GlaxoSmithKline, HLS Therapeutics, Janssen/Johnson & Johnson, Merck, Novartis, Novo Nordisk A/C, Pendopharm, Pfizer, Regeneron, Sanofi, and Servier; and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, and PERFUSE Research Institute. A.H. has received speaking honoraria from Bayer, Bristol Myers Squibb/Pfizer, and Servier. S.M. has received unrestricted research grants from AstraZeneca, Abbott Vascular, and Opsens; and speaker or advisory honoraria from AstraZeneca, Pfizer, Bristol Myers Squibb, Sanofi, Amgen, Boehringer Ingelheim, Bayer, Soundbite, Servier, Gilead, Abbott Vascular, and Novartis. R.C.W. has received research grant support and/or speaking/consulting honoraria from AstraZeneca, Boehringer Ingelheim, Bayer, and Pfizer. A.T.Y. has received research grant support from AstraZeneca. Stephane Rinfret has received consulting honoraria from Boston Scientific, Teleflex, Abbott Vascular, and Terumo. B.J.P. has received research grant support and/or speaker/consulting honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Edwards Lifescience, Novartis, Pfizer, and Servier. M.K.N. has received consulting/speaking honoraria from AstraZeneca, Bayer, Bristol Myers Squibb/Pfizer, Boston Scientific, and Edwards Canada. B.D. has received consulting fees/honoraria from Bayer, Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, and AstraZeneca. B.H. has received speaking honoraria from Abbott, AstraZeneca, Bayer, Bristol Myers Squibb, and Novartis. J.G. has received consulting and/or speaking honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, HLS Therapeutics, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, Sanofi, and Servier. J.-F.T. has received research grant support and/or consulting speaking honoraria from Abbott, Abbott Vascular, AstraZeneca, Bayer, Biosensors, Bristol-Myers Squibb/Pfizer Alliance, Daiichi-Sankyo, Idorsia, Novartis, and Servier. J.-P.D. has received speaker and consulting honoraria from Astra Zeneca, Bayer, Bristol-Myers Squibb /Pfizer, Boehringer Ingelheim, Servier, Sanofi, Amgen, and HLS Therapeutics. M.M. has served on the advisory board of Bayer Inc., Canada, and Sanofi Canada, and as site principal investigator on the RE-DUAL PCI study. B.E. has received speaking honoraria from Bayer. D.Y.F.S. has received unrestricted grant support (physician-initiated grant) from Eli Lilly Canada, Spartan Biosciences, Aggredyne, and Diapharma/Roche Diagnostics; has been a member of the advisory board and received honoraria from AstraZeneca Canada; has been a member of the advisory board for Bayer Canada; and has received honoraria from Abbott Vascular, Canada, and Servier Canada. A.B. has received consulting/speaking honoraria from Astra Zeneca, Bayer Inc., Bristol-Myers Squibb/Pfizer, Servier, Boehringer Ingelheim, HLS Therapeutics, and Abbott Vascular. The other authors have no conflicts of interest to disclose. Publisher Copyright: © 2021 The Authors

PY - 2021/12

Y1 - 2021/12

N2 - Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. Results: The median (25th, 75th percentile) CHADS2 score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). Conclusions: Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention.

AB - Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. Results: The median (25th, 75th percentile) CHADS2 score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). Conclusions: Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention.

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UR - http://www.scopus.com/inward/citedby.url?scp=85119909088&partnerID=8YFLogxK

U2 - 10.1016/j.cjco.2021.07.003

DO - 10.1016/j.cjco.2021.07.003

M3 - Article

C2 - 34993453

AN - SCOPUS:85119909088

SN - 2589-790X

VL - 3

SP - 1419

EP - 1427

JO - CJC Open

JF - CJC Open

IS - 12

ER -

Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study

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