The Lancet: OPTIMA-AF, Is 1 Month Enough After PCI? | JACC Baran

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD, welcome Yohei Sotomi, MD, PhD (The University of Osaka), and Ken Kozuma, MD, PhD (Teikyo University) for a special episode made possible through the JACC–Lancet partnership to discuss the OPTIMA-AF trial, published in The Lancet. In this investigator-initiated, multicenter randomized trial of 1,079 patients with atrial fibrillation undergoing PCI, 1 month of DOAC plus a P2Y12 inhibitor followed by DOAC monotherapy was compared with 12 months of dual antithrombotic therapy. The 1-month strategy met the prespecified noninferiority criterion for death or thromboembolic events and reduced major or clinically relevant non-major bleeding from 8.8% to 4.5%. The episode explores whether antithrombotic therapy after PCI can safely be shortened, how intracoronary imaging and contemporary PCI may influence this balance, and how the findings should be interpreted in clinical practice. Drs. Sotomi and Kozuma also take us behind the scenes of OPTIMA-AF, from an ambitious idea born through a research competition among Osaka University-affiliated hospitals, through COVID-related enrollment challenges and a prolonged recruitment period, to an initial rejection, appeal, extensive revision, and eventual publication in The Lancet.