New-onset or Pre-existing Atrial Fibrillation in Acute Coronary Syndromes: Two Distinct Phenomena With a Similar Prognosis

Autor: Marco Moccetti, Paul Erne, Raban Jeger, Marco Roffi, Tiziano Moccetti, Dragana Radovanovic, Luigi Biasco, Franz R. Eberli, Giovanni Pedrazzini, Hans Rickli
Přispěvatelé: University of Zurich, Pedrazzini, Giovanni
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Percutaneous
Cardiotonic Agents
Hemodynamics
610 Medicine & health
030204 cardiovascular system & hematology
11171 Cardiocentro Ticino
2705 Cardiology and Cardiovascular Medicine
New onset
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Risk Factors
Internal medicine
Atrial Fibrillation
Medicine
Humans
In patient
Myocardial infarction
Hospital Mortality
Prospective Studies
Registries
Medical prescription
Acute Coronary Syndrome
Referral and Consultation
Aged
medicine.diagnostic_test
business.industry
Atrial fibrillation
General Medicine
10060 Epidemiology
Biostatistics and Prevention Institute (EBPI)
medicine.disease
Prognosis
Patient Discharge
Hospitalization
Treatment Outcome
Angiography
Cardiology
ST Elevation Myocardial Infarction
Female
business
Switzerland
Popis: Introduction and objectives The management and risk stratification of patients with atrial fibrillation (AF) and acute coronary syndromes constitute a challenge. We aimed to evaluate the prognostic impact of AF whether present at admission or occurring during hospitalization for acute coronary syndromes, as well as trends in treatments and outcome. Methods Data derived from 35 958 patients enrolled between 2004 and 2015 in the AMIS Plus registry were retrospectively analyzed. Results Pre-existing AF (pre-AF) was present in 1644 (4.7%) while new-onset AF (new-AF) was evident in 309 (0.8%). Presentation with ST-segment elevation myocardial infarction and need for hemodynamic support was frequent in patients with AF, especially in those with new onset of the arrhythmia. A change of the medical and interventional approaches was observed with a progressive increase in oral anticoagulation prescription and referral for angiography and percutaneous coronary interventions in pre-AF patients. Despite different baseline risk profile and clinical presentations, both AF groups showed high in-hospital and 1-year mortality (in-hospital new-AF vs pre-AF [OR, 0.79; 95%CI, 0.53-1.17; P = .246]; 1-year mortality new-AF vs pre-AF [OR, 0.72; 95%CI, 0.31-1.67; P = .448]) Pre-AF but not new-AF independently predicted in-hospital mortality. While mortality declined over the study period for patients with pre-AF, it remained stable among new-AF patients. Conclusions While pre-AF is independently associated with in-hospital mortality, new-AF may reflect a worse hemodynamic impact of the acute coronary syndromes, with the latter ultimately driving the prognosis.
Databáze: OpenAIRE
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