“In our cohort, systematic use of DESs does not seem to be justified in most patients with AF because it was not associated with any clear advantage compared to BMSs,” the authors conclude.
Dr. Laurent Fauchier and colleagues at Universite Francois Rabelais in Tours, France, note that a consensus guideline recommends avoiding DES use in AF patients undergoing PCI unless indicated for clinical or anatomic reasons, but evidence from clinical trials is inconclusive.
They therefore evaluated morbidity and mortality outcomes in a retrospective study of 833 “real world” patients with atrial fibrillation who underwent PCI at their institution – 678 with a bare metal stent and 155 with a drug-eluting stent.
During a median follow-up of 688 days, the relative risk of major adverse cardiac events (i.e., death, MI, target lesion revascularization) with DES vs BMS was 1.24 (p=0.23), the team found. The risk of bleeding events was also virtually the same in the two groups (RR 0.98; p=0.95).
Furthermore, the results remained similar after adjustment for age and other confounding factors, the authors report.
Dr. Fauchier and colleagues acknowledge that the study represents the experience of only one institution and was not randomized in that operators chose the type of stent used.
Discussing the findings, they suggest, “An explanation for the absence of apparent benefit of DESs in this registry could be that operators succeeded in equalizing the risks and benefits of DESs or BMSs in patients with AF by an adequate selection of stent and antithrombotic treatment among different patient groups.”