Abstract 9496: Association Between Oral Anticoagulant Type and Hospital Readmission Rates Following Myocardial Infarction With Percutaneous Coronary Intervention in Patients With Nonvalvular Atrial Fibrillation

Abstract

Introduction: Clinical trials have shown improved outcomes with direct-acting oral anticoagulant (DOAC)- vs. warfarin-based regimens in patients with atrial fibrillation (AF) with acute coronary syndrome and/or undergoing percutaneous coronary intervention (PCI). This study investigated the impact of anticoagulant type on hospital readmission rates following a myocardial infarction (MI) managed with PCI in patients with nonvalvular AF (NVAF) in the real world. Methods: This was a retrospective, observational study using data from two US claims databases, Optum ® Research and PharMetrics ® Plus. Patients with NVAF who were hospitalized for MI, underwent PCI between January 1, 2014 and December 31, 2020, and initiated treatment with warfarin or a DOAC (dabigatran, rivaroxaban, apixaban, or edoxaban) exclusively during the index hospitalization or ≤365 days after discharge were included. Once identified, patients were followed for up to 12 months post-discharge. Hospital readmission rates at 30, 90, 180, and 365 days were compared for DOACs vs warfarin using multivariate Cox proportional hazards modeling. Results: The Optum cohort included 2647 patients (1997 DOAC, 650 warfarin) and the PharMetrics cohort included 2056 (1468 DOAC, 588 warfarin). In both cohorts, unadjusted all-cause, stroke/systemic embolism (SE)-related, and bleed-related hospital readmission rates were lower for DOACs vs warfarin at all timepoints. Regression analysis showed a significantly lower risk of hospital readmission with DOACs vs warfarin ( Table ). Conclusions: Real-world data from two large claims databases demonstrated that post-hospitalization DOAC treatment was associated with lower hospital readmission rates than warfarin treatment in patients with NVAF who were hospitalized for MI and underwent PCI. These results thus demonstrate the value of DOAC treatment for these patients.