title: Oral anticoagulation improves the prognosis of octogenarian patients with atrial fibrillation undergoing percutaneous coronary intervention and stenting.
abstract: BACKGROUND
  a significant proportion of octogenarian patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI) with stenting. Dual antiplatelet therapy is recommended in these patients, requiring a period of triple therapy with dual antiplatelet agent plus oral anticoagulation (OAC). Concerns remain regarding the appropriateness of OAC in octogenarians.
  
  
  METHODS
  we reviewed 604 patients (15.7% ≥80 years) with AF undergoing PCI. Clinical follow-up was performed, recording any bleeding episode, thrombo-embolism and major adverse cardiac events (MACE = death, acute myocardial infarction and/or revascularisation of target lesion). We compared octogenarian patients in relation to treatment with OAC at discharge. A secondary aim was to compare octogenarian patients with non-octogenarian patients in terms of their clinical and demographic characteristics, management and clinical outcome.
  
  
  RESULTS
  among the 604 patients, 95(15.7%) were aged ≥80 years. Octogenarians had a higher median CHADS2 score (2.78 versus 2.01; P < 0.001) and HAS-BLED score (3.05 versus 2.84; P = 0.028). After a follow-up of 17 ± 14 months, all-cause death occurred in 33%, MACE in 44%, and major bleeding in 21%. OAC was associated with less MACE (28.9 versus 58.3%; P = 0.012) and a similar rate of major bleeding. On multivariable analysis, non-use of OAC at discharge was associated with increased MACE (OR = 4.3; 95% CI = 1.3-14.6; P = 0.02).
  
  
  CONCLUSIONS
  octogenarian AF patients undergoing PCI/stenting have a high mortality rate and MACE, which can be reduced by means of OAC therapy.
authors.affiliation: Cardiology Unit, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Ctra Madrid-Cartagena s/n Ctra Madrid-Cartagena s/n, Murcia 30120,  Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Caballero
authors.forename: Juan M
authors.initials: JM
authors.lastname: Ruiz-Nodar
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.forename: Jose A
authors.initials: JA
authors.lastname: Hurtado
authors.forename: Jose
authors.initials: J
authors.lastname: Valencia
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernandez
authors.forename: Francisco
authors.initials: F
authors.lastname: Sogorb
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdes
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality / Q000534:rehabilitation; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants