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https://hdl.handle.net/2440/57003
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Type: | Journal article |
Title: | Prognostic impact of types of atrial fibrillation in acute coronary syndromes |
Author: | Lau, D. Huynh, L. Chew, D. Astley, C. Soman, A. Sanders, P. |
Citation: | American Journal of Cardiology, 2009; 104(10):1317-1323 |
Publisher: | Excerpta Medica Inc |
Issue Date: | 2009 |
ISSN: | 0002-9149 1879-1913 |
Statement of Responsibility: | Dennis H. Lau, Luan T. Huynh, Derek P. Chew, Carolyn M. Astley, Ashish Soman and Prashanthan Sanders |
Abstract: | Atrial fibrillation (AF) has been established as an independent predictor of long-term mortality after acute myocardial infarction. However, this is less well defined across the whole spectrum of acute coronary syndromes (ACSs). The Acute Coronary Syndrome Prospective Audit is a prospective multicenter registry with 12-month outcome data for 3,393 patients (755 with ST-segment elevation myocardial infarction, 1942 with high-risk non-ST-segment elevation ACS [NSTE-ACS], and 696 with intermediate-risk NSTE-ACS). A total of 149 patients (4.4%) had new-onset AF and 387 (11.4%) had previous AF. New-onset AF was more, and previous AF was less frequent in those with ST-segment elevation myocardial infarction than in those with high-risk NSTE-ACS or intermediate-risk NSTE-ACS (p <0.001). Compared to patients without arrhythmia, patients with new-onset AF and previous AF were significantly older and had more high-risk features at presentation (p <0.004). Patients with new-onset AF more often had left main coronary artery disease, resulting in a greater rate of surgical revascularization (p <0.001). Only new-onset AF resulted in adverse in-hospital outcomes (p <0.001). Only patients with previous AF had greater long-term mortality (hazard ratio 1.42, p <0.05). New-onset AF was only associated with a worse long-term composite outcome (hazard ratio 1.66, p = 0.004). However, the odds ratio for the composite outcome was greatest for patients with new-onset AF with intermediate-risk NSTE-ACS (odds ratio 3.9, p = 0.02) than for those with high-risk NSTE-ACS (odds ratio 2.0, p = 0.01) or ST-segment elevation myocardial infarction (odds ratio 1.4, p = 0.4). In conclusion, new-onset AF was associated with worse short-term outcomes and previous AF was associated with greater mortality even at long-term follow-up. The prognostic burden of new-onset AF differed with the type of ACS presentation. |
Keywords: | Humans Atrial Fibrillation Myocardial Infarction Recurrence Hemorrhage Creatine Kinase Cardiovascular Agents Electrocardiography Length of Stay Coronary Artery Bypass Severity of Illness Index Registries Hospital Mortality Risk Factors Prospective Studies Age Factors Heart Rate Aged Middle Aged Drug Utilization Australia Female Male Coronary Artery Disease Heart Failure Stroke Acute Coronary Syndrome Acute Kidney Injury |
DOI: | 10.1016/j.amjcard.2009.06.055 |
Published version: | http://dx.doi.org/10.1016/j.amjcard.2009.06.055 |
Appears in Collections: | Aurora harvest Medicine publications |
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