Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study

• Published in: PloS one 2020-01, Vol.15 (1), p.e0227571-e0227571
• Main Authors: Chang, Nen-Chung, Hu, Patrick, Chen, Tien-Hsing, Mao, Chun-Tai, Hung, Ming-Jui, Yeh, Chi-Tai, Hung, Ming-Yow
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Atrial Fibrillation - complications; Biology and Life Sciences; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Clinical trials; Cohort analysis; Cohort Studies; Confidence intervals; Coronary vessels; Diabetes mellitus; Dialysis; Drug delivery; Drug-Eluting Stents; Female; Fibrillation; Fibrinolytic Agents - chemistry; Fibrinolytic Agents - therapeutic use; Health insurance; Heart attacks; Hospitalization; Hospitals; Humans; Implantation; Implants; Internal medicine; Kidney diseases; Kidneys; Male; Medical schools; Medical technology; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Percutaneous Coronary Intervention; Population; Population studies; Population-based studies; Propensity Score; Proportional Hazards Models; Retrospective Studies; Review boards; Stents; Surgical implants; Thrombosis; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227571

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. 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. 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.