Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan.
Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan.
Int J Cardiol. 2019 Sep 15;291:63-68. doi: 10.1016/j.ijcard.2019.05.053. Epub 2019 May 23.
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.
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.
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 CHADS-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.
Our findings suggest that NG-DESs might reduce the risk of NOAF in patients with stable CAD.
新发心房颤动（NOAF）与冠心病（CAD）患者的不良结局相关。虽然新一代药物洗脱支架（NG-DES）在降低支架内再狭窄和血运重建风险方面优于裸金属支架（BMS），但在稳定性 CAD 患者中，与 BMS 植入相比，NG-DES 植入是否降低 NOAF 风险尚不清楚。
本基于人群的队列研究使用了来自台湾全民健康保险研究数据库的数据。采用倾向评分匹配，选择了 18423 对接受 NG-DES 植入和 BMS 植入的稳定性 CAD 患者，两组患者的基线特征相似，用于评估。采用竞争风险模型评估 NG-DES 组和 BMS 组的 NOAF 风险，其中死亡被视为竞争风险。
调整患者的临床变量后，与 BMS 相比，使用 NG-DES 与 1 年随访时的 NOAF 风险降低相关（调整后的亚分布风险比 [SHR] = 0.79，95%置信区间 [CI] = 0.68-0.93，P = 0.005）。类似的结果表明，与 BMS 相比，NG-DES 有利于降低 CHADS-VASc 评分≥2 的患者的 NOAF 风险（调整后的 SHR = 0.81，95%CI = 0.67-0.97，P = 0.020）。这些发现与支架植入后抗血小板治疗时间>1 个月的患者的结果一致。
我们的研究结果表明，NG-DES 可能降低稳定性 CAD 患者的 NOAF 风险。
