Key result
Drug-eluting stents were associated with a lower rate of the primary composite outcome compared to bare-metal stents at the end of follow-up (HR 0.81; 95% CI 0.69-0.96).
Why the study?
Acute myocardial infarction complicates the clinical management of atrial fibrillation because coronary stenting may influence subsequent antithrombotic therapy.
Does drug-eluting stent implantation reduce cardiovascular death and primary composite outcomes in patients with pre-existing atrial fibrillation and first acute myocardial infarction compared to bare-metal stents?
Cohort (n=1,221)
Yes
Does drug-eluting stent implantation reduce cardiovascular death and primary composite outcomes in patients with pre-existing atrial fibrillation and first acute myocardial infarction compared to bare-metal stents?
In patients with atrial fibrillation presenting with a first acute myocardial infarction, the use of drug-eluting stents is associated with reduced cardiovascular death and composite outcomes within the first year compared to bare-metal stents, though this benefit may not extend to patients with diabetes or severe kidney disease.
BACKGROUND: Acute myocardial infarction (AMI) complicates the clinical management of atrial fibrillation (AF) because coronary stenting may influence subsequent antithrombotic therapy. We investigated the use of a bare-metal stent (BMS) or a drug-eluting stent (DES) and associated outcomes in patients with pre-existing AF and first AMI undergoing percutaneous coronary intervention. METHODS AND RESULTS: Patient records in this population-based study were retrospectively collected from the Taiwan National Health Insurance Research Database. Using propensity score matching (PSM), we used 1:2 ratio stratification into a DES group of 436 and a BMS group of 785 patients from 2007 to 2011. The mean follow-up of matched cohorts was 1.7 years. After PSM, DESs were associated with lower rates of cardiovascular death (7.8%, hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.39-0.86 and 10.1%, HR 0.64, 95% CI 0.45-0.90) and primary composite outcome (35.1%, HR 0.76, 95% CI 0.63-0.92 and 48.2%, HR 0.81, 95% CI 0.69-0.96) than BMSs within the first year and at the end of follow-up. Although the greatest benefit from DESs, irrespective of the first- and second- generation DESs, implantation was observed within the first year only, this benefit was not observed in patients with diabetes, chronic kidney disease, or dialysis. CONCLUSIONS: Use of DESs in AMI patients with pre-existing AF is associated with significantly lower rates of cardiovascular death and primary composite outcome within the first year follow-up. However, the effect is not apparent in patients with diabetes, chronic kidney disease or dialysis.
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Chang et al. (2020) conducted a cohort in Pre-existing atrial fibrillation and first acute myocardial infarction (n=1,221). Drug-eluting stent vs. Bare-metal stent was evaluated on Primary composite outcome (HR 0.81, 95% CI 0.69-0.96). Drug-eluting stents were associated with a lower rate of the primary composite outcome compared to bare-metal stents at the end of follow-up (HR 0.81; 95% CI 0.69-0.96).
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