Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis

Abstract

Introduction: Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type ---new-onset (nAF) or pre-existing (pAF) ---is still controversial. Objectives: To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS). Methods: We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.3% male) admitted to a single center over a three-year period, with a six-month follow-up. Results: AF rhythm was identified in 14.5% patients, of whom 71.4% presented nAF and 28.6% pAF. When AF types were compared, patients with nAF more frequently presented with STelevation ACS (p=0.003). Patients with pAF, in turn, were older (p=0.032), had greater left atrial diameter (p=0.001) and were less likely to have significant coronary lesions (p=0.034). Regarding therapeutic strategy, nAF patients were more often treated by rhythm control during hospital stay (p<0.001) and were less often anticoagulated at discharge (p=0.001). Compared with the population without AF, nAF was a predictor of death during hospital stay in univariate (p<0.001) and multivariate analysis (OR 2.67, p=0.047), but pAF was not. During follow-up, pAF was associated with higher mortality (p=0.014), while nAF patients presented only a trend towards worse prognosis. Conclusions: AF during the acute phase of ACS appears to have a negative prognostic impact only in patients with nAF and not in those with pAF. 2174-2049Document downloaded from http://www.elsevier.pt, day 01/07/2015. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. ST (p=0,003). Por sua vez, a FAp foi mais comum em doentes idosos (p=0,032), com diâmetro superior da aurícula esquerda (p=0,001) e ausência de doença coronária (p=0,034). Quanto à estratégia terapêutica, os doentes com FAn foram mais vezes submetidos a controlo de ritmo durante o internamento (p<0,001), mas menos hipocoagulados à alta (p=0,001). Quando comparada com a população sem FA, a FAn foi preditora de morte hospitalar na análise univariada (p<0,001) e multivariada (OR 2,67, p=0,047), enquanto a FAp não. Já no follow-up, a FAp associou-se a maior mortalidade (p=0,014), enquanto os doentes com FAn apresentaram apenas uma tendência para um pior prognóstico. Conclusões: O impacto prognóstico negativo da FA na fase aguda das SCA parece ocorrer apenas nos doentes que apresentam FAn e não naqueles com FAp. PALAVRAS-CHAVE

New‐onset atrial fibrillation in patients with acute coronary syndrome may be associated with worse prognosis and future heart failure

“…Atrial fibrillation (AF) occurs in 6%-21% of patients with acute coronary syndrome (ACS). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] AF causes loss of "atrial kick," tachycardia and irregular rhythm because it decreases cardiac output. 16,17 Therefore, it has been considered that ACS patients with AF have a worse prognosis than patients without AF.…”

“…Several studies have identified increased mortality attributed to complication of ACS with AF. [1][2][3][4][5][7][8][9][11][12][13][14][15][18][19][20][21][22][23][24][25][26][27] However, there is controversy as to whether AF is an independent predictor. 4,14,22,27 Thus, it is thought that clinical factors other than AF may determine prognosis.…”

“…4,14,22,24,27 Previous reports have suggested that mortality differed in patients with pre-existing AF or new-onset AF. Some reports directly compared each type of AF, 2,5,6,8,[11][12][13][14][15]23,25 and in some of the studies there were indications that new-onset AF worsened the prognosis 2,5,8,11,12,14,15,23 ; however, others concluded that new-onset AF did not worsen the prognosis. 6,13,25 The aim of this study was to evaluate the prognostic value of AF as a complicating factor in patients with ACS, in the current PCI era; comparisons were made among non-AF and all-AF groups, and between non-AF, new-onset AF, and pre-existing AF groups.…”

New-Onset Atrial Fibrillation in the Post-Primary PCI Setting: A Systematic Review

“…However, confounding eff ects on the mortality of acute STEMI with NOAF in comparison with those without AF are possible due to baseline LV dysfunction, higher Killip class and cardiogenic shock [6]. Morbidity is also higher in patients with NOAF due to the increased risk of LV dysfunction, stroke and bleeding events [7]. This review explores the available evidence on the incidence and major predictors of NOAF, and highlights its prognostic signifi cance in invasively treated acute STEMI patients.…”

Anticoagulant therapy in atrial fibrillation with acute coronary syndrome in real clinical practice according to the total register of acute coronary syndrome in the Krasnodar Territory

“…Наличие ФП у больного ОКС независимо от типа (с подъемом и без подъема сегмента ST) повышает вероятность ишемических и геморрагических событий и риск фатального исхода. ФП потенцирует ишемию миокарда, выраженность СН, существенно повышает риск кардиоэмболических событий, в том числе ишемического инсульта, и ухудшает прогноз [7,8]. И ОКС, и ФП требуют проведения активной антитромботической терапии.…”