Impact of direct oral anticoagulants on target lesion revascularization rates in patients with chronic coronary syndrome.

BACKGROUND

Percutaneous coronary intervention (PCI) is a widely used treatment strategy for coronary artery disease. Optimal long-term antithrombotic therapy after PCI remains challenging.

OBJECTIVES

This substudy of the Vienna PCI Registry assessed long-term effects of direct oral anticoagulant (DOAC) use on major adverse cardiac events (MACEs) in patients with chronic coronary syndrome (CCS) after PCI, exploring possible pleiotropic effects.

METHODS

We analyzed patients with CCS from the Vienna PCI Registry treated with a drug-eluting stent (DES) between 2015 and 2020. The primary end point was clinically driven target lesion revascularization (TLR). The secondary composite end point (MACE) included TLR, target vessel revascularization (TVR), stent thrombosis (ST), and all-cause death. Patients received either triple antithrombotic therapy (TAT; DOAC, aspirin, and clopidogrel), followed by DOAC monotherapy, or dual antiplatelet therapy (DAPT; aspirin and clopidogrel), followed by single antiplatelet therapy.

RESULTS

Among 1046 patients with CCS, 176 (16.8%) received TAT followed by DOAC monotherapy. The primary end point TLR occurred significantly less often in TAT-treated patients (2.8% vs 8.4%). MACE rates were similar between TAT and DAPT groups (17.0% vs 17.0%). All-cause mortality was higher in the TAT group (11.9% vs 7.8%). Multivariable regression showed that TAT followed by DOAC monotherapy was associated with a reduced 5-year risk of TLR compared with DAPT followed by single antiplatelet therapy (odds ratio, 0.367; 95% CI, 0.147-0.917; P =.032).

CONCLUSION

Patients treated with TAT demonstrated a statistically significant risk decrease for the primary end point clinically driven TLR in the elective CCS-PCI setting at 5 years' follow-up, which may be in part due to pleiotropic effects of DOACs.