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Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation.

Publication ,  Journal Article
Hess, CN; Peterson, ED; Peng, SA; de Lemos, JA; Fosbol, EL; Thomas, L; Bhatt, DL; Saucedo, JF; Wang, TY
Published in: J Am Coll Cardiol
August 11, 2015

BACKGROUND: Antithrombotic therapy for acute myocardial infarction (MI) with atrial fibrillation (AF) among higher risk older patients treated with percutaneous coronary intervention (PCI) remains unclear. OBJECTIVES: This study sought to determine appropriate antithrombotic therapy for acute MI patients with AF treated with PCI. METHODS: We examined 4,959 patients ≥65 years of age with acute MI and AF who underwent coronary stenting (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). The primary effectiveness outcome was 2-year major adverse cardiac events (MACE) comprising death, readmission for MI, or stroke; the primary safety outcome was bleeding readmission. Outcomes with dual antiplatelet therapy (DAPT) or triple therapy (DAPT plus warfarin) were compared using Cox proportional hazard modeling with inverse probability-weighted propensity adjustment. RESULTS: Among 4,959 patients, 27.6% (n = 1,370) were discharged on triple therapy. Relative to DAPT, patients on triple therapy had a similar risk of MACE (adjusted hazard ratio [HR]: 0.99 [95% confidence interval (CI): 0.86 to 1.16]) but significantly greater risk of bleeding requiring hospitalization (adjusted HR: 1.61 [95% CI: 1.31 to 1.97]) and greater risk of intracranial hemorrhage (adjusted HR: 2.04 [95% CI: 1.25 to 3.34]). Of 1,591 Medicare Part D patients, 90-day post-discharge warfarin persistence among patients discharged on warfarin was 93.2% (n = 412). Results of 90-day landmark analyses comparing triple therapy versus DAPT in patients persistently on warfarin versus those not discharged on warfarin who had not filled a warfarin prescription were similar to our primary findings. CONCLUSIONS: Approximately 1 in 4 older AF patients undergoing PCI for MI were discharged on triple therapy. Those receiving triple therapy versus DAPT had higher rates of major bleeding without a measurable difference in composite MI, death, or stroke.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

August 11, 2015

Volume

66

Issue

6

Start / End Page

616 / 627

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Stroke
  • Registries
  • Purinergic P2Y Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Male
  • Humans
 

Citation

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Hess, C. N., Peterson, E. D., Peng, S. A., de Lemos, J. A., Fosbol, E. L., Thomas, L., … Wang, T. Y. (2015). Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation. J Am Coll Cardiol, 66(6), 616–627. https://doi.org/10.1016/j.jacc.2015.05.062
Hess, Connie N., Eric D. Peterson, S Andrew Peng, James A. de Lemos, Emil L. Fosbol, Laine Thomas, Deepak L. Bhatt, Jorge F. Saucedo, and Tracy Y. Wang. “Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation.J Am Coll Cardiol 66, no. 6 (August 11, 2015): 616–27. https://doi.org/10.1016/j.jacc.2015.05.062.
Hess CN, Peterson ED, Peng SA, de Lemos JA, Fosbol EL, Thomas L, et al. Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation. J Am Coll Cardiol. 2015 Aug 11;66(6):616–27.
Hess, Connie N., et al. “Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation.J Am Coll Cardiol, vol. 66, no. 6, Aug. 2015, pp. 616–27. Pubmed, doi:10.1016/j.jacc.2015.05.062.
Hess CN, Peterson ED, Peng SA, de Lemos JA, Fosbol EL, Thomas L, Bhatt DL, Saucedo JF, Wang TY. Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation. J Am Coll Cardiol. 2015 Aug 11;66(6):616–627.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

August 11, 2015

Volume

66

Issue

6

Start / End Page

616 / 627

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Stroke
  • Registries
  • Purinergic P2Y Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Male
  • Humans