Heart and Vessels

, Volume 33, Issue 9, pp 986–996 | Cite as

Real-world antithrombotic therapies and clinical outcomes after second-generation drug-eluting stent implantation in patients with atrial fibrillation: a multi-center cohort study

  • Hisao Otsuki
  • Junichi Yamaguchi
  • Kazuho Kamishima
  • Hiroyuki Arashi
  • Nobuhisa Hagiwara
Original Article


Previous reports have focused on cardiovascular and bleeding events in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, antithrombotic treatment strategies and clinical outcomes after second-generation drug-eluting stents (DES) implantation in AF patients remain to be determined. We enrolled 244 consecutive AF patients treated with second-generation DES. The study population was derived from multi-center AF registry (including 8 centers in Japan) from 2010 to 2012. Prescription of antithrombotic agents and clinical outcomes were retrospectively examined. Ninety-two patients (37.7%) were prescribed dual antiplatelet therapy (DAPT) at discharge and 152 patients (62.3%) were given DAPT plus oral anticoagulation (OAC) with warfarin. The median follow-up period was 730 days. Kaplan–Meier analysis showed that major adverse cardiac and cerebrovascular events (MACCE) were not significantly different (2-year event rate, 17.6 vs. 13.5%, p = 0.37), but bleeding events were significantly higher in the DAPT plus OAC group than in the DAPT group (2-year event rate, 6.1 vs. 17.9%, p = 0.033). In a sub-analysis of DAPT plus OAC patients, adequate time in the therapeutic range (TTR) group (TTR ≥ 65%) was not significantly different from the suboptimal OAC group (TTR < 65%) for bleeding events, but it had a lower incidence of MACCE, resulting in better net clinical outcomes (composite of MACCE and major bleeding, 2-year event rate, 9.2 vs. 27.8%, p = 0.008). DAPT plus OAC remains more common in AF patients undergoing PCI with second-generation DES. Under adequate TTR, DAPT plus OAC showed better net clinical outcomes by reducing MACCE without increasing bleeding.


Antithrombotic therapy Atrial fibrillation Percutaneous coronary intervention Second-generation drug-eluting stent 



Collaborating centers and investigators: We would like to thank the following collaborating centers and investigators: Sendai Cardiovascular Center: Mayui Nakazawa Keigo Kambayashi, Naoki Iiduka and Shinya Fujii; Saiseikai Kurihashi Hospital: Yusuke Inagaki, Hiromu Kadowaki, Arata Nomura, Tonre Ri, Eiji Shibahashi, Yuta Morioka and Yoshimi Ohta; Saiseikai Kawaguchi Hospital: Risako Nakao, Yutaka Terashima, Suguru Matsumoto, Atsushi Yamamoto and Atsushi Takagi; Nishiarai Heart Center: Ahsung Kim, Katsumi Saito; Tokyo Metropolitan Tama Medical Center Hospital: Masataka Ogiso and Hiroyuki Tanaka; Yokohama Medical Center: Kyoichiro Yazaki, Masahiro Watanabe and Fumiaki Mori; Tokyo Women’s Medical University Yachiyo Medical Center: Keiko Endo, Koichiro Miura, Takahiro Yamada and Atsushi Honda; Tokyo Womens Medical University: Yusuke Tanigaito, Kaoru Iwasa, Hisao Otsuki, Kensuke Shimazaki, Kazuki Tanaka, Masashi Nakao, Kazuho Kamishma, Kentaro Jujo, Hiroyuki Arashi, Junichi Yamaguchi, and Nobuhisa Hagiwara.

English language editing: We thank Editage ( for English language editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

380_2018_1148_MOESM1_ESM.pdf (316 kb)
Supplementary Figure 1. Kaplan-Meier curve for adverse events (DAPT vs. DAPT plus OAC). Cumulative incidences of (A) Stroke, (B) Ischemic stroke, (C) Hemorrhagic stroke, (D) TIMI minor bleeding, and (E) TIMI major bleeding are presented. DAPT = dual antiplatelet therapy; OAC = oral anticoagulation; TIMI = thrombolysis in myocardial infarction. Supplementary Figure 2. Kaplan-Meier curve for adverse events (adequate vs. adequate TTR). Cumulative incidences of (A) Stroke, (B) Ischemic stroke, and (C) Hemorrhagic stroke are presented. PCI = percutaneous coronary intervention; TTR = time in therapeutic range (PDF 374 kb)


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Hisao Otsuki
    • 1
  • Junichi Yamaguchi
    • 1
  • Kazuho Kamishima
    • 1
  • Hiroyuki Arashi
    • 1
  • Nobuhisa Hagiwara
    • 1
  1. 1.Department of Cardiology, The Heart Institute of JapanTokyo Women’s Medical UniversityTokyoJapan

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