One-year outcome of patients with atrial fibrillation undergoing coronary artery stenting: an analysis of the AFCAS registry

Clin Cardiol. 2014 Jun;37(6):357-64. doi: 10.1002/clc.22254. Epub 2014 Jan 30.


Background: Most evidence regarding the efficacy and safety of the antithrombotic regimens for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI-S) derives from small, single-center, retrospective datasets. To obtain further data on this issue, we carried out the prospective, multicenter, observational Management of patients with Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) registry ( identifier NCT00596570).

Hypothesis: We hypothesize that the antithrombotic treatment of AF patients undergoing PCI-S is variable and the clinical outcome may vary according to the different regimens.

Methods: Consecutive AF patients undergoing PCI-S at 17 European institutions were included and followed for 1 year. Outcome measures included: (1) major adverse cardiac/cerebrovascular events (MACCE), including all-cause death, myocardial infarction, repeat revascularization, stent thrombosis, or stroke/transient ischemic attack, and (2) bleeding, and were compared according to the antithrombotic regimen adopted. A propensity-score analysis was carried out to adjust for baseline and procedural differences.

Results: Out of the 975 patients enrolled, 914 were included in the final analysis. The mean CHADS2 score was 2.2 ± 1.2, and 71% of patients had a CHADS2 score ≥2. Triple therapy (TT) of vitamin K antagonist (VKA), aspirin, and clopidogrel was prescribed to 74% of patients, dual antiplatelet therapy to 18%, and VKA plus clopidogrel to 8%. At 1-year follow-up, no significant differences were found in the occurrence of MACCE and bleeding among the 3 antithrombotic regimens, even when adjusted for propensity score.

Conclusions: In this large, real-world population of AF patients undergoing PCI-S, TT was the antithrombotic regimen most frequently prescribed. Although several limitations need to be acknowledged, in our study the 1-year efficacy and safety of TT, dual antiplatelet therapy, and VKA plus clopidogrel was comparable.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aspirin / therapeutic use
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / drug therapy*
  • Clopidogrel
  • Coronary Vessels / surgery*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Male
  • Percutaneous Coronary Intervention / methods
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prospective Studies
  • Registries / statistics & numerical data*
  • Stents*
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use
  • Vitamin K / antagonists & inhibitors


  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Vitamin K
  • Clopidogrel
  • Ticlopidine
  • Aspirin

Associated data