부산대학교 도서관

Aims The efficacy and safety of ticagrelor or prasugrel vs. clopidogrel in patients with atrial fibrillation (AF) on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI) have not been established. Methods and results This was a nationwide cohort study of patients on OAC for AF who underwent PCI for MI from 2011 through 2019 and were prescribed a [P2Y.sub.12] inhibitor at discharge. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of death from any cause, stroke, recurrent MI, or repeat revascularization. The primary safety outcome was cerebral, gastrointestinal, or urogenital bleeding requiring hospitalization. Absolute and relative risks for outcomes at 1 year were calculated through multivariable logistic regression with average treatment effect modelling. Outcomes were standardized for the individual components of the [CHA.sub.2][DS.sub.2]-VASc and HAS-BLED scores as well as type of OAC, aspirin, and proton pump inhibitor use. We included 2259 patients of whom 1918 (84.9%) were prescribed clopidogrel and 341 (15.1%) ticagrelor or prasugrel. The standardized risk of MACE was significantly lower in the ticagrelor or prasugrel group compared with the clopidogrel group (standardized absolute risk, 16.3% vs. 19.4%; relative risk, 0.84, 95% confidence interval, 0.70-0.98; P = 0.02), while the risk of bleeding did not differ (standardized absolute risk, 5.5% vs. 5.1%; relative risk, 1.07, 95% confidence interval, 0.73-1.41; P = 0.69). Conclusion In patients with AF on OAC who underwent PCI for MI, treatment with ticagrelor or prasugrel vs. clopidogrel was associated with reduced ischaemic risk, without a concomitantly increased bleeding risk. Graphical Abstract Ticagrelor or prasugrel versus clopidogrel in patients with atrial fibrillation undergoing percutaneous coronary intervention for myocardial infarction Methods First time myocardial infarction undergoing percutaneous coronary intervention History of atrial fibrillation and on oral anticoagulation Major findings Ticagrelor or prasugrel treatment was associated with reduced risk of major adverse cardiovascular events without an increased risk of bleeding compared with clopidogrel Keywords Myocardial infarction * Atrial fibrillation * Triple antithrombotic therapy * Double antithrombotic therapy * [P2Y.sub.12] inhibitor
Introduction Coronary artery disease and atrial fibrillation (AF) frequently coexist, and the concomitant presence of both conditions is associated with an increased risk of adverse cardiovascular events. (1,2) In addition, [...]