Risk of new-onset atrial fibrillation after drug-eluting stent implantation in patients with stable coronary artery disease

Chao Feng Lin, Ya Hui Chang, Cheng Huang Su, Hung Yi Liu, Li Nien Chien

Research output: Contribution to journalArticle

Abstract

Background: New-onset atrial fibrillation (NOAF) is associated with adverse outcomes in patients with coronary artery disease (CAD). Although newer generation drug-eluting stents (NG-DESs) are more beneficial than bare-metal stents (BMSs) in reducing the risk of in-stent restenosis and revascularization, whether NG-DES implantation in patients with stable CAD reduces NOAF risk compared with BMS implantation remains unknown. Methods: This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database. Propensity score matching was used to select 18,423 pairs of patients with stable CAD receiving NG-DES implantation and BMS implantation with similar baseline characteristics for evaluation. A competing risk model was used to evaluate the risk of NOAF between the NG-DES and BMS groups in which death was considered a competing risk. Results: After adjustment for patients' clinical variables, the use of NG-DESs was associated with a decreased risk of NOAF at 1-year follow-up (adjusted subdistribution hazard ratio [SHR] = 0.79, 95% confidence interval [CI] = 0.68–0.93, P = 0.005) compared with the use of BMSs. Similar results indicated that NG-DESs were beneficial for reducing the risk of NOAF (adjusted SHR = 0.81, 95% CI = 0.67–0.97, P = 0.020) in patients with a CHA2DS2-VASc score of ≥2. These findings were also consistent with those for patients who received dual antiplatelet therapy for an undefined duration of >1 month following stent implantation. Conclusions: Our findings suggest that NG-DESs might reduce the risk of NOAF in patients with stable CAD.

Original languageEnglish
Pages (from-to)63-68
Number of pages6
JournalInternational Journal of Cardiology
Volume291
DOIs
Publication statusPublished - Sep 15 2019

Fingerprint

Drug-Eluting Stents
Atrial Fibrillation
Coronary Artery Disease
Stents
Metals
Confidence Intervals
Propensity Score
National Health Programs
Taiwan
Cohort Studies
Databases
Research

Keywords

  • Atrial fibrillation
  • Bare-metal stent
  • Coronary artery disease
  • Drug-eluting stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk of new-onset atrial fibrillation after drug-eluting stent implantation in patients with stable coronary artery disease. / Lin, Chao Feng; Chang, Ya Hui; Su, Cheng Huang; Liu, Hung Yi; Chien, Li Nien.

In: International Journal of Cardiology, Vol. 291, 15.09.2019, p. 63-68.

Research output: Contribution to journalArticle

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abstract = "Background: New-onset atrial fibrillation (NOAF) is associated with adverse outcomes in patients with coronary artery disease (CAD). Although newer generation drug-eluting stents (NG-DESs) are more beneficial than bare-metal stents (BMSs) in reducing the risk of in-stent restenosis and revascularization, whether NG-DES implantation in patients with stable CAD reduces NOAF risk compared with BMS implantation remains unknown. Methods: This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database. Propensity score matching was used to select 18,423 pairs of patients with stable CAD receiving NG-DES implantation and BMS implantation with similar baseline characteristics for evaluation. A competing risk model was used to evaluate the risk of NOAF between the NG-DES and BMS groups in which death was considered a competing risk. Results: After adjustment for patients' clinical variables, the use of NG-DESs was associated with a decreased risk of NOAF at 1-year follow-up (adjusted subdistribution hazard ratio [SHR] = 0.79, 95{\%} confidence interval [CI] = 0.68–0.93, P = 0.005) compared with the use of BMSs. Similar results indicated that NG-DESs were beneficial for reducing the risk of NOAF (adjusted SHR = 0.81, 95{\%} CI = 0.67–0.97, P = 0.020) in patients with a CHA2DS2-VASc score of ≥2. These findings were also consistent with those for patients who received dual antiplatelet therapy for an undefined duration of >1 month following stent implantation. Conclusions: Our findings suggest that NG-DESs might reduce the risk of NOAF in patients with stable CAD.",
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AU - Chien, Li Nien

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