AVIATOR-2: Antithrombotic Strategy Variability in Atrial Fibrillation and Obstructive Coronary Disease Revascularized with Percutaneous Coronary Intervention Registry

Background
The optimal antithrombotic treatment (ATT) after percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) is unclear. Multiple ATT combinations are possible with currently available antiplatelet and anticoagulant therapies. Recent randomized trials have demonstrated safety of dual therapy with a non-vitamin K antagonist, however, real-world prospective evaluation of outcomes after PCI are limited. We sought to determine the efficacy and safety of triple therapy (TT) vs. non-TT regimens after contemporary PCI in AF patients. We also sought to describe real world patterns of ATT prescribed after AF-PCI and to evaluate physician & patient factors impacting decision making.

Methods
The AVIATOR 2 international registry is a multicenter prospective observational study that enrolled 514 AF PCI patients across 11 sites. ATT choice was at physician’s discretion. After PCI, physicians completed a questionnaire regarding factors influencing their selection of ATT. Patients also completed a questionnaire addressing their understanding of clinical risk and the importance of prescribed medications. The primary efficacy outcome was 1 year major adverse cardiac and cerebrovascular events (MACCE) [composite all-cause death, myocardial infarction (MI), stroke, stent thrombosis or clinically driven target lesion revascularization] with triple therapy (TT) vs. non-TT regimens. The primary safety endpoint was clinically significant bleeding defined as Bleeding Academic Research Consortium (BARC) category 2, 3 or 5 with TT vs. non-TT regimens after PCI.

Results
Enrolled patients had a mean age of 73.1 ± 9.0 and 25.9% were women with a median CHA2DS2-VASc score of 4 (3-5). Approximately 66% were discharged on TT after PCI and 34% were discharged on non-TT regimens, including 20% patients on dual therapy and 14% on dual antiplatelet therapy. One-year clinical outcomes in TT vs. non-TT patients, as well as secondary study endpoints will be available at the time of the presentation.

Conclusions
The AVIATOR-2 registry will describe current patterns of ATT prescription after contemporary AF-PCI and associations between TT compared to non-TT regimens on 1-year MACCE, bleeding and net adverse clinical events.