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Current status of antithrombotic therapy and in-hospital outcomes in patients with atrial fibrillation undergoing percutaneous coronary intervention in Germany

Aktueller Stand der antithrombotischen Therapie und stationäre Ergebnisse bei Patienten mit Vorhofflimmern nach perkutaner Koronarintervention in Deutschland

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Abstract

Background

Little is known about current patterns of antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) in clinical practice in Germany.

Methods

The RIVA-PCI is a prospective, non-interventional, multicenter study with follow-up until hospital discharge including consecutive patients with AF undergoing PCI.

Results

Between January 2018 and March 2020, 1636 patients (elective in 52.6%, non-ST elevation acute coronary syndrome [NSTE-ACS] in 39.3%, ST-elevation myocardial infarction in 8.2%) from 51 German hospitals were enrolled in the study. After PCI a dual antithrombotic therapy (DAT) consisting of OAC and a P2Y12 inhibitor was given to 66.0%, triple antithrombotic therapy (TAT) to 26.0%, dual antiplatelet therapy to 5.5%, and a mono-therapy to 2.5% of the patients. Non-vitamin K antagonist oral anticoagulants (NOACs) were given to 82.4% and vitamin K antagonists to 11.5% of the patients. In-hospital events included death in 12 cases (0.7%), myocardial infarction, stent thrombosis, and ischemic stroke in four (0.2%) patients each, while 2.8% of patients had bleeding complications. The recommended durations for DAT or TAT at discharge were 1 month (1.5%), 3 months (2.1%), 6 months (43.1%), and 12 months (45.6%), with a 6-month course of DAT (47.7%) most often recommended after elective PCI and a 12-month course of DAT (40.1%) after ACS.

Conclusion

The preferred therapy after PCI in patients with AF is DAT with a NOAC and clopidogrel. In-hospital ischemic and bleeding events were rare. The recommended durations for combination therapy vary considerably.

Zusammenfassung

Hintergrund

Über die aktuellen, im klinischen Alltag in Deutschland angewandten Schemata zur antithrombotischen Therapie bei Patienten mit Vorhofflimmern (VF), bei denen eine perkutane Koronarintervention (PCI) durchgeführt wird, ist nur wenig bekannt.

Methoden

Das RIVA-PCI-Register („Rivaroxaban in patients with atrial fibrillation undergoing PCI“) stellt eine prospektive nichtinterventionelle Multizenterstudie mit Nachbeobachtung bis zur Krankenhausentlassung dar und bezieht aufeinanderfolgende Patienten mit VF ein, bei denen eine PCI erfolgt.

Ergebnisse

Zwischen Januar 2018 und März 2020 wurden 1636 Patienten (elektiv in 52,6%, akutes Koronarsyndrom ohne ST-Strecken-Hebung [NSTE-ACS] in 39,3%, ST-Hebungs-Myokardinfarkt in 8,2% der Fälle) aus 51 deutschen Krankenhäusern in die Studie aufgenommen. Nach PCI wurde eine duale antithrombotische Therapie (DAT) mit oralen Antikoagulanzien (OAK) und einem P2Y12-Inhibitor bei 66,0%, eine dreifache („triple“) antithrombotische Therapie (TAT) bei 26,0%, eine duale Plättchenhemmung bei 5,5% und eine Monotherapie bei 2,5% der Patienten durchgeführt. Nicht-Vitamin-K-abhängige orale Antikoagulanzien (NOAC) wurden 82,4% und Vitamin-K-Antagonisten 11,5% der Patienten verordnet. Zu den Ereignissen während des stationären Aufenthalts zählten Tod in 12 Fällen (0,7%), Myokardinfarkt, Stentthrombose und ischämischer Schlaganfall jeweils bei 4 (0,2%) Patienten, während 2,8% der Patienten Blutungskomplikationen aufwiesen. Die empfohlene Dauer für die DAT oder TAT bei Entlassung betrug einen Monat (1,5%), 3 Monate (2,1%), 6 Monate (43,1%) bzw. 12 Monate (45,6%), dabei wurde meistens (47,7%) eine 6‑monatige DAT nach elektiver PCI und eine 12-monatige DAT (40,1%) nach ACS empfohlen.

Schlussfolgerung

Die bevorzugte Therapie nach PCI bei Patienten mit VF besteht in einer DAT mit einem NOAK und Clopidogrel. Ischämische und Blutungsereignisse während des stationären Aufenthalts waren selten. Die empfohlenen Dauern für die Kombinationstherapie variieren beträchtlich.

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Acknowledgements

List of investigators (in the order of the number of enrolled patients): Dr. med. Ralph Toelg, Segeberger Kliniken GmbH, Bad Segeberg; Prof. Dr. med. Harm Wienbergen, Klinikum Links der Weser Bremen, Bremen; Prof. Dr. med. Uwe Zeymer, Klinikum der Stadt Ludwigshafen, Ludwigshafen; Dr. med. Hans-Peter Hobbach, Kreisklinikum Siegen, Siegen; Dr. med. Alessandro Cuneo, Krankenhaus und MVZ Maria-Hilf Stadtlohn, Stadtlohn; Prof. Dr. med. Raffi Bekeredjian, Robert-Bosch-Klinikum, Stuttgart; Prof. Dr. med. OliverRitter, Klinikum Brandenburg Havel, Brandenburg; Prof. Dr. med. Birgit Hailer; Kath. Kliniken Essen-Nord-West gGmbH, Essen; Dr. med. Klaus Hertting, Krankenhaus Buchholz und Winsen GmbH, Buchholz; Prof. Dr. med. Marcus Hennersdorf, SLK-Kliniken Heilbronn GmbH, Heilbronn; Dr. med. Werner Scholz, Herz- und Diabeteszentrum, Bad Oeynhausen; PD. Dr. med. Peter Lanzer, Gesundheitszentrum Bitterfeld Wolfen, Bitterfeld; Prof. Dr. med. Harald Mudra, Städt. Krankenhaus Neuperlach-München, München; Dr. med. Markus Schwefer, Elblandkliniken Stifung & Co. KG Elblandklinikum Riesa, Riesa; Prof. Dr. med. Peter-Lothar Schwimmbeck, Klinikum Leverkusen, Leverkusen; Dr. med. Christoph Liebetrau, Kerckhoff-Klinik GmbH, Bad Nauheim; Dr. med. Steffen Schnupp, Klinikum Coburg, Coburg; Dr. med. Frank Hamann, Klinikum Konstanz, Konstanz; Prof. Dr. med. Rainer Zotz, Marienhausklinikum Bitburg-Neuenburg, Bitburg; Prof. Dr. med. Matthias Leschke, Klinikum Esslingen, Esslingen; Dr. med. Martin Dißmann, Vivantes Humboldt-Klinikum, Berlin; Dr. med. Christoph Kadel, Klinikum Frankfurt Höchst, Frankfurt; PD Dr. med. Michael Gross, Johanniter-Krankenhaus Genthin—Stendal gGmbH, Stendal; Dr. med. Dirk Härtel, Klinikum Lippe-Detmold, Detmold; PD. Dr. med. Sandra Erbs, Herzzentrum Leipzig GmbH, Leipzig; Prof. Dr. med. Ibrahim Akin, Universitätsklinikum Mannheim, Mannheim; Dr. med. Christopher Bengel, MTK Klinikum Bad Soden, Bad Soden; PD Dr. med. Lutz Büllesfeld; GFO Kliniken Bonn, St. Marien-Hospital, Bonn; Prof. Dr. med. Jan Torzewski; Herz- und Gefäßzentrum Oberallgäu-Kempten gGmbH, Kempten; Dr. med. Jan Guggemos, Gemeinschaftskrankenhaus Havelhöhe, Berlin; Prof. Dr. med. Werner Jung, Schwarzwald-Baar Klinikum, Villingen-Schwenningen; PD. Dr. med.Bernhard Witzenbichler, Helios Amper Klinikum Dachau, Dachau; Prof. Dr. med. Florian Bea, Krankenhaus Freudenstadt, Freudenstadt; PD. Dr. med. Marc Kollum, Hegau-Bodensee-Klinikum Singen, Singen; Prof. Dr. med.Rüdiger Dißmann, Klinikum Bremerhaven Reinkenheide, Bremerhaven; Dr. med. Murat Yildiz, Hospital zum Heiligen Geist, Fritzla; Prof. Dr. med. Dirk Sibbing, Klinikum der Universität München-Großhadern, München; Dr. med. Stefan Zimmermann, Klinikum Bayreuth GmbH, Bayreuth; Dr. med. Simon Ohm; Sana Kliniken Düsseldorf GmbH, Düsseldorf, PD Dr. med. Peter Nordbeck, Universitätsklinikum Würzburg, Würzburg; Dr. med. Jan Johannsen, Ostalb-Klinikum Aalen, Aaalen; Dr. med. Felix Schmidt, Klinikum Chemnitz GmbH, KH Küchwald, Chemnitz; Dr. med. Stefan Hoffmann, Klinikum Barnim GmbH Werner Forßmann Krankenhaus, Eberswalde; Dr. med. Bernhard Vieregge, Krankenhaus Neustadt am Rübenberge, Neustadt; Dr. med. Achim Gutersohn, St. Marienhospital Vechta, Vechta; Dr. med. Z. Hatahet, Kreisklinik Altötting, Altötting; Prof. Dr. med. Martin Andrassy, Fürst-Stirum-Klinik, Bruchsal; Dr. med. Norbert Kaul, Stiftungsklinikum Mittelrhein, Koblenz; Dr. med. Norbert Klein, Klinikum St. Georg gGmbH, Leipzig; Prof. Dr. med. Grigorios Korosoglou, GRN-Klinik Weinheim, Weinheim; Dr. med. Oliver Gastmann, Ilm-Kreis-Kliniken, Arnstadt-Ilmenau gGmbH, Arnstadt.

Funding

The RIVA-PCI registry has been supported by an unrestricted grant of the Bayer-Vital GmbH, Germany.

Author information

Authors and Affiliations

  1. Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany

    Uwe Zeymer & Ralf Zahn

  2. Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany

    Uwe Zeymer, Christoph Claas & Thomas Riemer

  3. Segeberger Kliniken GmbH, Bad Segeberg, Germany

    Ralph Toelg

  4. Klinikum Links der Weser Bremen, Bremen, Germany

    Harm Wienbergen

  5. Kreisklinikum Siegen, Siegen, Germany

    Hans-Peter Hobbach

  6. Krankenhaus und MVZ Maria-Hilf Stadtlohn, Stadtlohn, Germany

    Alessandro Cuneo

  7. Robert-Bosch-Klinikum, Stuttgart, Germany

    Raffi Bekeredjian

  8. Klinikum Brandenburg Havel, Brandenburg, Germany

    Oliver Ritter

  9. Katholische Kliniken Essen-Nord-West gGmbH, Essen, Germany

    Birgit Hailer

  10. Krankenhaus Buchholz und Winsen GmbH, Buchholz, Germany

    Klaus Hertting

  11. SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany

    Marcus Hennersdorf

  12. Herz- und Diabeteszentrum, Bad Oeynhausen, Germany

    Werner Scholtz

  13. Gesundheitszentrum Bitterfeld Wolfen, Bitterfeld, Germany

    Peter Lanzer

  14. Städtisches Krankenhaus Neuperlach-München, München, Germany

    Harald Mudra

  15. Elblandklinikum Riesa, Riesa, Germany

    Markus Schwefer

  16. Klinikum Leverkusen, Leverkusen, Germany

    Peter-Lothar Schwimmbeck

  17. Kerckhoff-Klinik GmbH, Bad Nauheim, Germany

    Christoph Liebetrau

  18. Herzzentrum Leipzig und Universität Leipzig, Leipzig, Germany

    Holger Thiele

Authors
  1. Uwe Zeymer
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  2. Ralph Toelg
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  3. Harm Wienbergen
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  7. Oliver Ritter
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  8. Birgit Hailer
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  9. Klaus Hertting
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  10. Marcus Hennersdorf
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  11. Werner Scholtz
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  12. Peter Lanzer
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  13. Harald Mudra
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  14. Markus Schwefer
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  15. Peter-Lothar Schwimmbeck
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  16. Christoph Liebetrau
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  17. Holger Thiele
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  18. Christoph Claas
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  19. Thomas Riemer
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  20. Ralf Zahn
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Corresponding author

Correspondence to Uwe Zeymer.

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Conflict of interest

U. Zeymer: speakers honoraria from Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Daicchi Sankyo, Pfizer, Sanofi; M. Hennersdorf: speakers honoraria from Astra Zeneca, Bayer, Berlin Chemie, Daiichi Sankyo. H. Wienbergen, H.-P. Hobbach, R. Toelg, A. Cuneo, R. Bekeredjian, O. Ritter, B. Hailer, K. Hertting, W. Scholtz, P. Lanzer, H. Mudra, M. Schwefer, P.‑L. Schwimmbeck, C. Liebetrau, H. Thiele, C. Claas, T. Riemer and R. Zahn declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Zeymer, U., Toelg, R., Wienbergen, H. et al. Current status of antithrombotic therapy and in-hospital outcomes in patients with atrial fibrillation undergoing percutaneous coronary intervention in Germany. Herz 48, 134–140 (2023). https://doi.org/10.1007/s00059-022-05099-6

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