Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study
Autoři:
Nen-Chung Chang aff001; Patrick Hu aff002; Tien-Hsing Chen aff004; Chun-Tai Mao aff004; Ming-Jui Hung aff004; Chi-Tai Yeh aff005; Ming-Yow Hung aff007
Působiště autorů:
Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
aff001; University of California, Riverside, Riverside, California, United States of America
aff002; Department of Cardiology, Riverside Medical Clinic, Riverside, California, United States of America
aff003; Division of Cardiology, Department of Medicine and Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Keelung City, Taiwan
aff004; Department of Medical Research and Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
aff005; Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan
aff006; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
aff007; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
aff008
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0227571
Souhrn
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.
Klíčová slova:
Death rates – Hemorrhage – Stent implantation – Myocardial infarction – Atrial fibrillation – Anticoagulant therapy – Coronary stenting – Revascularization
Zdroje
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