Long-Term Outcomes of Anticoagulation Monotherapy Versus Combination Therapy in Atrial Fibrillation Patients with Complex Coronary Artery Disease

BACKGROUND The optimal antithrombotic regimen for patients with atrial fibrillation (AF) and multivessel disease undergoing complex percutaneous coronary intervention (PCI) remains controversial, particularly with high ischemic and complex coronary anatomy. MATERIAL AND METHODS We retrospectively recruited 56 AF patients with SYNTAX scores >22 who underwent PCI January 2018-December 2023. Patients were grouped by antithrombotic strategy 1 year after PCI, as follows: oral anticoagulant (OAC) alone (monotherapy group, n=32) or OAC plus antiplatelet therapy (APT; dual-therapy group, n=24). RESULTS Baseline demographics, comorbidities, and coronary disease severity were comparable. At 1-year follow-up, composite endpoint rates were significantly higher in the dual-therapy group (66.7%) than monotherapy group (28.1%, P=0.006). Revascularization rates were notably higher in the dual-therapy group (50.0% vs 12.5%, P=0.003), including target lesion (33.3% vs 9.4%, P=0.041) and target vessel revascularization (37.5% vs 9.4%, P=0.019). One year after index PCI, continued dual therapy was associated with a significantly increased risk of revascularization (HR: 4.003, 95% CI: 1.287-12.450, P=0.017) in univariate Cox regression analysis. CONCLUSIONS In AF patients with complex coronary artery disease, continuation of OAC plus APT beyond 1 year after PCI was associated with higher adverse clinical outcomes and greater need for repeat revascularization, compared with OAC alone, suggesting long-term OAC monotherapy represents a safer and equally effective alternative for selected high-risk patients. However, given the retrospective design and limited sample size of our study, OAC monotherapy warrants prospective validation in AF patients with complex PCI, as our retrospective results should be regarded as hypothesis-generating.