Impact of Atrial Fibrillation on Acute Coronary Syndrome–Analysis of In-Hospital Outcomes and 30-Day Readmissions

Narasimhan, Bharat; Patel, Neelkumar; Chakraborty, Sandipan; Bandyopadhyay, Dhrubajyoti; Sreenivasan, Jayakumar; Hajra, Adrija; Amgai, Birendra; Rai, Devesh; Krittanawong, Chayakrit; Kaul, Risheek; Ho, Kam Sing; Mehran, Roxana; Naidu, Srihari S.; Mehta, Devendra I.

doi:10.1016/j.cpcardiol.2020.100764

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…Although the underlying mechanism of age and atrial fibrillation (AF) remains unclear, it has been recognized as one of the major risk factors for POAF after CABG [ 16 – 18 ]. In the case of POAF after CABG, the patient's cardiac function can be negatively affected, leading to circulatory instability and myocardial ischemia, which then affects the patient's postoperative recovery, resulting in longer ICU stays, longer hospital stays, increased medical costs, increased IABP requirements, and even death [ 19 – 21 ]. According to this study, POAF was a common complication both in on-pump and off-pump CABG, and the incidence of POAF was about 25% in younger patients (≤ 65 years old), and about 30% in older patients (> 65 years old).…”

Section: Discussionmentioning

confidence: 99%

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

Zhang

Wang

et al. 2023

J Cardiothorac Surg

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Objectives We aimed to identify in-hospital outcomes in young (≤ 65 years) and old (> 65 years) patients after coronary artery bypass grafting (CABG) by analyzing the effect of age on adverse events after on-pump or off-pump CABG. Methods Patients older than 65 years were defined as older patients and others were defined as younger patients. The qualitative data were compared by chi-square or Fisher's exact tests. The quantitative data were compared by the two-sample independent t-test or Mann–Whitney U test. Multifactor binary logistic regression was used to control for confounders and to investigate the effect of age on dichotomous outcome variables such as death. Results In the on-pump CABG population, the postoperative in-hospital mortality, the incidence of postoperative symptomatic cerebral infarction (POSCI) and postoperative atrial fibrillation (POAF) was higher in older patients than in younger patients (P value < 0.05), and age > 65 years was associated with postoperative in-hospital mortality (OR = 2.370, P value = 0.031), POSCI (OR = 5.033, P value = 0.013), and POAF (OR = 1.499, P value < 0.001). In the off-pump CABG population, the incidence of POAF was higher in older patients than in younger patients (P value < 0.05), and age > 65 years was associated with POAF (OR = 1.392, P value = 0.011). Conclusion In-hospital outcomes after CABG are strongly influenced by age. In on-pump CABG, the risk of postoperative death, POSCI, and POAF was higher in older patients, and in off-pump CABG, the risk of POAF was higher in older patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

Zhang

Wang

et al. 2023

J Cardiothorac Surg

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“…In this regard, predicting algorithms had been developed for risk assessment and subsequent treatment advice. Previous studies have demonstrated that patients with concurrent ACS and AF appeared to be strongly associated with short‐ and long‐term mortality and thrombotic events 3,11 . Thus, it is essential to identify individuals at high risk and adopt proper therapeutic interventions to improve their prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Atrial fibrillation (AF) remains a commonly encountered complication in acute coronary syndrome (ACS) patients 1 . With a significant overlap of risk factors, concomitant AF may result in short‐ and long‐term worse clinical outcomes in patients with ACS 2,3 . It is, therefore, important to identify individuals at high risk and adopt proper management strategies to improve their prognosis.…”

Section: Introductionmentioning

confidence: 99%

“… 1 With a significant overlap of risk factors, concomitant AF may result in short‐ and long‐term worse clinical outcomes in patients with ACS. 2 , 3 It is, therefore, important to identify individuals at high risk and adopt proper management strategies to improve their prognosis. In this regard, current guidelines recommend the use of CHA 2 DS 2 ‐VASc risk score for risk assessment and subsequent treatment guidance in patients with co‐morbid ACS and AF.…”

Section: Introductionmentioning

confidence: 99%

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N‐terminal pro‐B‐type natriuretic peptide improves the predictive value of CHA₂DS₂‐VASc risk score for long‐term cardiovascular events in acute coronary syndrome patients with atrial fibrillation

Qiu

et al. 2023

Clinical Cardiology

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Background: It is important to identify patients with co-morbid acute coronary syndrome (ACS) and atrial fibrillation (AF) at high risk and adopt proper management strategies to improve their prognosis.Hypothesis: The addition of N-terminal pro-B-type natriuretic peptide (NT-proBNP) could improve predictive value for long-term cardiovascular events beyond the CHA 2 DS 2 -VASc score in patients with co-morbid ACS and AF.Methods: A total of 1223 patients with baseline NT-proBNP between January 2016 and December 2019 were included in the study. The primary endpoint was all-cause death at 12 months. The secondary outcomes included 12-month cardiac death and major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction, or stroke.Results: A higher serum of NT-proBNP levels was strongly associated with increased risks of all-cause death (adjusted hazard ratio [HR]: 1.05, 95% confidence interval [CI], 1.03-1.07), cardiac death (adjusted HR: 1.05, 95% CI, 1.03-1.07), and MACCE (adjusted HR: 1.04, 95% CI, 1.02-1.06). The prognostic accuracy of the CHA 2 DS 2 -VASc score was improved when combined with NT-proBNP to yield a 9%, 11%, and 7% increment for the discrimination of long-term risk for all-cause mortality (area under curve [AUC]: from 0.64 to 0.73), cardiac death (AUC: from 0.65 to 0.76), and MACCE (AUC: from 0.62 to 0.69), respectively.Conclusions: In patients with ACS and AF, NT-proBNP is a potential biomarker to enhance risk discrimination for all-cause death, cardiac death, and MACCE in combination with the CHA 2 DS 2 -VASc score.

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“…AF is a well-established marker of poor short-and longterm prognosis in patients with ACS and is associated with an increased risk of overall mortality. An analysis derived from 1558205 ACS patients observed that patients with AF had significantly longer and more complicated hospital stays with nearly double adjusted in-hospital mortality [19]. Pilgrim et al [20] showed that among patients with CAD undergoing revascularization with drug-eluting stents (DES), AF conferred a rising risk of both all-cause mortality and ischemic stroke during four-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI

Mo¹,

Yang²,

Zhang³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Early risk stratification of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has relevant implication for individualized management strategies. The -VASc and GRACE ACS risk model are well-established risk stratification systems. We aimed to assess their prognostic performance in AF patients with ACS or PCI. Methods: Consecutive patients with AF and ACS or referred for PCI were prospectively recruited and followed up for 3 years. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, systemic embolism and ischemia-driven revascularization. Results: Higher -VASc (HR [hazard ratio] 1.184, 95% CI 1.091–1.284) and GRACE at discharge score (HR 1.009, 95% CI 1.004–1.014) were independently associated with increased risk of MACCEs. The -VASc (c-statistics: 0.677) and GRACE at discharge (c-statistics: 0.699) demonstrated comparable discriminative capacity for MACCEs ( p = 0.281) while GRACE at admission provided relatively lower discrimination (c-statistics: 0.629, p vs. -VASc = 0.041). For predicting all-cause mortality, three models displayed good discriminative capacity (c-statistics: 0.750 for -VASc, 0.775 for GRACE at admission, 0.846 for GRACE at discharge). A significant discrimination improvement of GRACE at discharge compared to -VASc was detected (NRI = 45.13%). Conclusions: In the setting of coexistence of AF and ACS or PCI, -VASc and GRACE at discharge score were independently associated with an increased risk of MACCEs. The GRACE at discharge performed better in predicting all-cause mortality.

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Impact of Atrial Fibrillation on Acute Coronary Syndrome–Analysis of In-Hospital Outcomes and 30-Day Readmissions

Cited by 7 publications

References 23 publications

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

N‐terminal pro‐B‐type natriuretic peptide improves the predictive value of CHA₂DS₂‐VASc risk score for long‐term cardiovascular events in acute coronary syndrome patients with atrial fibrillation

Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI

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Impact of Atrial Fibrillation on Acute Coronary Syndrome–Analysis of In-Hospital Outcomes and 30-Day Readmissions

Cited by 7 publications

References 23 publications

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

N‐terminal pro‐B‐type natriuretic peptide improves the predictive value of CHA2DS2‐VASc risk score for long‐term cardiovascular events in acute coronary syndrome patients with atrial fibrillation

Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI

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Product

Resources

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N‐terminal pro‐B‐type natriuretic peptide improves the predictive value of CHA₂DS₂‐VASc risk score for long‐term cardiovascular events in acute coronary syndrome patients with atrial fibrillation