Abstract 13402: Selection of Stent Types Among AMI patients With Atrial Fibrillation: National Patterns From NCDR ACTION Registry - GWTG 2008-2014

Abstract

Background: Patients receiving an oral anticoagulant on top of dual antiplatelet therapy are known to be at high risk for bleeding events; thus the selection of drug-eluting stents (DES) versus bare metal stents (BMS) can have important implications for acute MI patients with atrial fibrillation (AF). Methods: From the NCDR ACTION Registry - GWTG, we identified 14,427 AF patients presenting with acute MI undergoing PCI from 2008-2014. Temporal trends and hospital variation in DES use were examined as were patterns of use by stroke risk (CHA 2 DS 2 -VASc) and bleeding risk (ATRIA). Results: Overall, DES was used in 58.9% of MI patients with AF. This rate increased from 47.1% in 2008 to 67.9% in 2014 (p<0.001). Use of DES vs BMS varied widely among hospitals (median 60% DES implantation, interquartile range 50% - 74%) (Figure). Relative to BMS patients, those receiving DES were younger (median age 72 years vs. 75 years) but had more comorbidities such as diabetes, dyslipidemia, prior MI, and prior revascularization (all p<0.001). DES placement was more common than BMS placement among patients at high stroke risk (CHA 2 DS 2 -VASc ≥ 2) and high bleeding risk (ATRIA ≥ 4) (59% and 56%, respectively, p<0.01 for both) Although aspirin and a P2Y12 inhibitor were prescribed in >95% of all patients, warfarin was prescribed at discharge less frequently among patients receiving DES than BMS (31% vs. 39%, p<0.001) Conclusions: Use of DES among MI patients with AF has increased over time, yet substantial hospital-level variation is observed. Patients with AF meeting indication for anticoagulation are still more likely to receive DES than BMS, even among those at both high predicted stroke risk and bleeding risk. Those with AF receiving DES were however less likely to receive warfarin therapy.