To examine patterns of preadmission and discharge antithrombotic therapies in coronary
artery disease (CAD) and atrial fibrillation (AF) patients admitted for acute myocardial
infarction (AMI), we performed a retrospective analysis of the Acute Coronary Treatment
and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG),
which captures consecutive AMI patients treated at participating US hospitals. We
included patients with CAD, AF, and CHA2DS2-VASc score ≥2 admitted for AMI (07/01/2013–09/30/2016). In the 15,034 AMI patients
with previous AF and CAD, median age was 75; 32% were female. Preadmission, 32% of
patients were on P2Y12 inhibitors, 36% were anticoagulated, 72% were on aspirin, and 5% were on triple therapy.
At discharge post-AMI, 73% were prescribed P2Y12 inhibitors and 41% anticoagulation. Discharge anticoagulation use did not vary directly
with CHA2DS2-VASc score; 16% of previously anticoagulated patients had discontinued anticoagulation
at discharge. In patients receiving anticoagulants at discharge, 27% used nonvitamin
K antagonist oral anticoagulants. Triple therapy was prescribed in 23% at discharge;
27% of these were with nonvitamin K antagonist oral anticoagulants and 14% with prasugrel
or ticagrelor. P2Y12 inhibitors and anticoagulants without aspirin were used in 2%. In conclusion, patients
with previous CAD and AF are undertreated for both recurrent ischemic events and stroke
prevention. After AMI hospitalization, P2Y12 inhibition was preferentially selected over oral anticoagulation.
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Article info
Publication history
Published online: September 26, 2018
Accepted:
September 13,
2018
Received in revised form:
September 7,
2018
Received:
July 11,
2018
Footnotes
Funding: This work was funded by the National Cardiovascular Data Registry. The NCDR had no role in the study design, in collection, analysis, and interpretation of data, in writing the report, or in the decision to submit the manuscript.
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