Real-World Antithrombotic Management of Nonvalvular Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention in China: A Cross-Sectional Study

Abstract

Antithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) undergoing percutaneous coronary intervention (PCI) is clinically challenging, with real-world strategies often remaining inconsistent. This study analyzed 2020 annual data from the Shanghai Cardiac Intervention Quality Control Center, encompassing 23,115 patients who underwent PCI across 36 centers in Shanghai. Among these, 1306 (5.65%) patients with a confirmed diagnosis of NVAF were enrolled. Dual antiplatelet therapy (DAPT) was the most common antithrombotic regimen (584, 44.7%). Anticoagulation therapy was administered to only 478 (55.8%) of male patients with a CHA₂DS₂-VASc score of ≥ 2 and 207 (55.6%) of female patients with a CHA₂DS₂-VASc score of ≥ 3. Significant differences were observed across antithrombotic strategy groups regarding gender distribution, age, atrial fibrillation (AF) type, coronary artery disease type, and history of congestive heart failure (CHF), hypertension, stroke, or myocardial infarction (MI). Patients receiving oral anticoagulants (OACs) showed higher rates of persistent AF (53.2% vs. 33.9%, p < 0.001) and more frequent histories of CHF and stroke. Conversely, patients not receiving OAC therapy demonstrated a higher proportion of paroxysmal AF (66.1% vs. 46.8%, p < 0.001) and prior MI. A substantial gap persists between guideline recommendations and real-world antithrombotic management in Chinese AF patients undergoing PCI. Key challenges include the underutilization of OAC therapy, a high prevalence of reduced-dose anticoagulation, and a potential overreliance on DAPT. These findings highlight the urgent need to improve adherence to evidence-based guidelines and conduct personalized risk–benefit assessments.