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Arrhythmia Watch Editorial Staff


Clinical Articles

Stenting outcomes compared in AF patients

The routine use of drug-eluting stents (DES) does not seem to be justified in patients with atrial fibrillation (AF) since it confers a higher risk of major bleeding.

Patients with AF are considered a high-risk population for percutaneous coronary intervention (PCI) with stent implantation. There are uncertainties about the optimal antithrombotic treatment strategy in these patients.

A retrospective cohort study of AF patients who underwent PCI with implantation of at least one stent was carried out by Ruiz-Nodar and colleagues (1). From 604 patients reviewed, 414 were matched using propensity score matching: 207 received a DES and 207 a bare-metal stent (BMS). Patients were followed up clinically, and all bleeding episodes, thrombotic events and major adverse cardiac events were recorded.

The incidence of major adverse cardiovascular events (MACE) was similar for both groups (4.26 DES and 4.44 BMS per 10,000 days of exposure), as was the incidence of death (3.4 and 3.5, respectively, per 10,000 days of exposure). There was a higher incidence of major bleeding in the DES group (2.26 versus 1.19 per 10,000 days of exposure, p=0.03).

This was a high-risk population. At three years, the mortality rate was 26.8% in the BMS group and 28.0% in the DES group. The MACE rates at three years were 34% and 37%, respectively. Predictive factors for adverse events were age, chronic AF, chronic renal failure, and non-use of coumarin at discharge.

The authors suggest that the higher risk of major bleeding observed with DES in this study (associated with prolonged antiplatelet therapy) means that routine use of DES is not justified in patients with AF. Use of DES should be restricted to lesions at high risk of restenosis.


  1. Ruiz-Nodar JM, Marín F, Sánchez-Payá J et al. Efficacy and safety of drug-eluting stent use in patients with atrial fibrillation. Eur Heart J 2009; 30: 932-9.

Published on: June 7, 2009

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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