NOAC and Risk of Myocardial Infarction in Patients with AF with/without PCI: a Meta-Analysis

Abstract

Aim: The aim was to assess the risk of Myocardial Infarction (MI) and MACE during non-vitamin K antagonist therapy (NOAC) compared to warfarin in patients with Atrial Fibrillation (AF) both treated and not treated with Percutaneous Angioplasty (PCI). Methods and Results: Eight randomized clinical trials with a total of 81,943 patients were selected by a systematic search. Dabigatran compared to warfarin significantly increased the risk of MI (RR 1.38, 95% CI: 1.14-1.67), while the FXa inhibitors effect did not differ significantly from warfarin (RR 0.96, 95% CI: 0.86- 1.09). The comparison of relative risks between analyzed subgroups (dabigatran vs. FXa inhibitors) showed a significant difference (Chi²=9.51, df=1, p=0.002). In a network meta-analysis, dabigatran 110mg b.i.d. increased the risk of MI compared to warfarin, apixaban, edoxaban and rivaroxaban. Dabigatran 150mg b.i.d. increased the risk of MI compared to warfarin, apixaban, and rivaroxaban. We estimated the treatment ranking of the best therapy for MI prevention in patients with AF treated with PCI. Rivaroxaban had a 90% probability of being ranked the best therapy for MI prevention, whereas dabigatran 110mg had an 8.2% probability. Dabigatran 150mg was the most effective in stroke prevention (-94% probability). Conclusion: Each NOAC is associated with different risk of MI. Furthermore, FXa inhibitors should be considered as the first line NOACs in patients with AF and coronary artery disease.