Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines
BackgroundPatients receiving oral anticoagulation in addition to dual‐antiplatelet therapy are known to be at high risk for bleeding events; thus, the selection of a drug‐eluting stent (DES) versus a bare metal stent (BMS) can have important implications for patients with atrial fibrillation (AF) pr...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.005280 |
| _version_ | 1818775035213512704 |
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| author | Amit N. Vora Tracy Y. Wang Shuang Li Karen Chiswell Connie Hess Renato D. Lopes Sunil V. Rao Eric D. Peterson |
| author_facet | Amit N. Vora Tracy Y. Wang Shuang Li Karen Chiswell Connie Hess Renato D. Lopes Sunil V. Rao Eric D. Peterson |
| author_sort | Amit N. Vora |
| collection | DOAJ |
| description | BackgroundPatients receiving oral anticoagulation in addition to dual‐antiplatelet therapy are known to be at high risk for bleeding events; thus, the selection of a drug‐eluting stent (DES) versus a bare metal stent (BMS) can have important implications for patients with atrial fibrillation (AF) presenting with acute myocardial infarction (MI). Methods and ResultsFrom the National Cardiovascular Data Registry ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines, we identified 14 427 AF patients presenting with acute MI undergoing percutaneous coronary intervention from 2008 to 2014. Temporal trends and hospital variation in DES use were examined, as were patterns of use by stroke risk (CHA2DS2‐VASc) and bleeding risk ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation). Among patients with linked Medicare data (n=2844), multivariable Cox regression modeling was used to compare risks for a composite outcome (all‐cause mortality, readmission for stroke, or MI), readmission for stroke, revascularization, and major bleeding at 1 year. A DES was used in 8414 (58.9%) MI patients with AF, increasing from 47.1% in 2008 to 67.9% in 2014, with wide variation among hospitals. DES placement was more common than BMS placement among patients at high stroke risk (CHA2DS2‐VASc ≥2) and high bleeding risk (ATRIA ≥4). Although aspirin and a P2Y12 inhibitor were prescribed for >95% of all patients regardless of stent type at discharge, warfarin was prescribed less frequently among patients receiving a DES than a BMS (31% versus 39%, P<0.001). The composite outcome was similar between patients with a DES or BMS at 1 year (22% versus 26%; adjusted hazard ratio: 0.88; 95% confidence interval [CI], 0.76–1.03). ConclusionsUse of DESs among MI patients with AF has increased over time, but substantial hospital‐level variation was observed. Patients with AF meeting indications for anticoagulation are more likely to receive a DES than a BMS, even among those at high predicted risk of both stroke and bleeding. |
| first_indexed | 2024-12-18T10:50:38Z |
| format | Article |
| id | doaj.art-2d5565b00ec1412d8f4539cb5fb5be69 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T10:50:38Z |
| publishDate | 2017-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-2d5565b00ec1412d8f4539cb5fb5be692022-12-21T21:10:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-08-016810.1161/JAHA.116.005280Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the GuidelinesAmit N. Vora0Tracy Y. Wang1Shuang Li2Karen Chiswell3Connie Hess4Renato D. Lopes5Sunil V. Rao6Eric D. Peterson7Duke Clinical Research Institute, Duke University Medical Center, Durham, NCDuke Clinical Research Institute, Duke University Medical Center, Durham, NCDuke Clinical Research Institute, Duke University Medical Center, Durham, NCDuke Clinical Research Institute, Duke University Medical Center, Durham, NCUniversity of Colorado School of Medicine, Aurora, CODuke Clinical Research Institute, Duke University Medical Center, Durham, NCDuke Clinical Research Institute, Duke University Medical Center, Durham, NCDuke Clinical Research Institute, Duke University Medical Center, Durham, NCBackgroundPatients receiving oral anticoagulation in addition to dual‐antiplatelet therapy are known to be at high risk for bleeding events; thus, the selection of a drug‐eluting stent (DES) versus a bare metal stent (BMS) can have important implications for patients with atrial fibrillation (AF) presenting with acute myocardial infarction (MI). Methods and ResultsFrom the National Cardiovascular Data Registry ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines, we identified 14 427 AF patients presenting with acute MI undergoing percutaneous coronary intervention from 2008 to 2014. Temporal trends and hospital variation in DES use were examined, as were patterns of use by stroke risk (CHA2DS2‐VASc) and bleeding risk ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation). Among patients with linked Medicare data (n=2844), multivariable Cox regression modeling was used to compare risks for a composite outcome (all‐cause mortality, readmission for stroke, or MI), readmission for stroke, revascularization, and major bleeding at 1 year. A DES was used in 8414 (58.9%) MI patients with AF, increasing from 47.1% in 2008 to 67.9% in 2014, with wide variation among hospitals. DES placement was more common than BMS placement among patients at high stroke risk (CHA2DS2‐VASc ≥2) and high bleeding risk (ATRIA ≥4). Although aspirin and a P2Y12 inhibitor were prescribed for >95% of all patients regardless of stent type at discharge, warfarin was prescribed less frequently among patients receiving a DES than a BMS (31% versus 39%, P<0.001). The composite outcome was similar between patients with a DES or BMS at 1 year (22% versus 26%; adjusted hazard ratio: 0.88; 95% confidence interval [CI], 0.76–1.03). ConclusionsUse of DESs among MI patients with AF has increased over time, but substantial hospital‐level variation was observed. Patients with AF meeting indications for anticoagulation are more likely to receive a DES than a BMS, even among those at high predicted risk of both stroke and bleeding.https://www.ahajournals.org/doi/10.1161/JAHA.116.005280atrial fibrillationmyocardial infarctionstent |
| spellingShingle | Amit N. Vora Tracy Y. Wang Shuang Li Karen Chiswell Connie Hess Renato D. Lopes Sunil V. Rao Eric D. Peterson Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation myocardial infarction stent |
| title | Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines |
| title_full | Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines |
| title_fullStr | Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines |
| title_full_unstemmed | Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines |
| title_short | Selection of Stent Type in Patients With Atrial Fibrillation Presenting With Acute Myocardial Infarction: An Analysis From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry—Get With the Guidelines |
| title_sort | selection of stent type in patients with atrial fibrillation presenting with acute myocardial infarction an analysis from the action acute coronary treatment and intervention outcomes network registry get with the guidelines |
| topic | atrial fibrillation myocardial infarction stent |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.005280 |
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