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 |
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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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