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Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation.
Heart. 2008 Jul; 94(7):867-73.H

Abstract

OBJECTIVE

To assess variables associated with the occurrence of atrial fibrillation (AF) and the relation of AF with short- and long-term outcomes and with other in-hospital complications in patients with acute coronary syndromes (ACS) with and without ST-segment elevation.

DESIGN

Pooled database of 120 566 patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation (NSTE) ACS enrolled in 10 clinical trials. Multivariable logistic regression and Cox proportional hazards modelling were used to identify factors associated with AF and its relation with clinical outcomes.

SETTING

ACS complicated by AF.

PATIENTS

120,566 patients with STEMI and NSTE-ACS in 10 clinical trials.

INTERVENTIONS

None evaluated.

MAIN OUTCOME MEASURE

Short- and long-term mortality.

RESULTS

Occurrence of AF was 7.5% in the overall population (STEMI 8.0% (n = 84 161); NSTE-ACS = 6.4% (n = 36,405)). Seven-day mortality was higher for patients with AF (5.1%) than for those without (1.6%). After adjusting for confounders, association of AF with 7-day mortality was present in STEMI (hazards ratio (HR) = 1.65; 95% CI 1.44 to 1.90) and NSTE-ACS (HR = 2.30; 95% CI 1.83 to 2.90; p interaction = 0.015). Risk of long-term mortality (day 8 to 1 year) was also higher in STEMI (HR = 2.37; 95% CI 1.79 to 3.15) and NSTE-ACS (HR = 1.67; 95% CI 1.41 to 1.99). AF had a larger impact in NSTE-ACS on risk of short-term mortality (p<0.001), stroke (p<0.001), ischaemic stroke (p<0.001) and moderate or severe bleeding (p<0.001).

CONCLUSIONS

AF is more common in patients with STEMI. An association of AF with short- and long-term mortality among patients with STEMI and NSTE-ACS was found. Understanding these findings may lead to better care of patients with this common arrhythmia.

Authors+Show Affiliations

Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Room 0311 Terrace Level, Durham, NC 27707, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

18332062

Citation

Lopes, R D., et al. "Short- and Long-term Outcomes Following Atrial Fibrillation in Patients With Acute Coronary Syndromes With or Without ST-segment Elevation." Heart (British Cardiac Society), vol. 94, no. 7, 2008, pp. 867-73.
Lopes RD, Pieper KS, Horton JR, et al. Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation. Heart. 2008;94(7):867-73.
Lopes, R. D., Pieper, K. S., Horton, J. R., Al-Khatib, S. M., Newby, L. K., Mehta, R. H., Van de Werf, F., Armstrong, P. W., Mahaffey, K. W., Harrington, R. A., Ohman, E. M., White, H. D., Wallentin, L., & Granger, C. B. (2008). Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation. Heart (British Cardiac Society), 94(7), 867-73. https://doi.org/10.1136/hrt.2007.134486
Lopes RD, et al. Short- and Long-term Outcomes Following Atrial Fibrillation in Patients With Acute Coronary Syndromes With or Without ST-segment Elevation. Heart. 2008;94(7):867-73. PubMed PMID: 18332062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation. AU - Lopes,R D, AU - Pieper,K S, AU - Horton,J R, AU - Al-Khatib,S M, AU - Newby,L K, AU - Mehta,R H, AU - Van de Werf,F, AU - Armstrong,P W, AU - Mahaffey,K W, AU - Harrington,R A, AU - Ohman,E M, AU - White,H D, AU - Wallentin,L, AU - Granger,C B, Y1 - 2008/03/10/ PY - 2008/3/12/pubmed PY - 2008/10/25/medline PY - 2008/3/12/entrez SP - 867 EP - 73 JF - Heart (British Cardiac Society) JO - Heart VL - 94 IS - 7 N2 - OBJECTIVE: To assess variables associated with the occurrence of atrial fibrillation (AF) and the relation of AF with short- and long-term outcomes and with other in-hospital complications in patients with acute coronary syndromes (ACS) with and without ST-segment elevation. DESIGN: Pooled database of 120 566 patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation (NSTE) ACS enrolled in 10 clinical trials. Multivariable logistic regression and Cox proportional hazards modelling were used to identify factors associated with AF and its relation with clinical outcomes. SETTING: ACS complicated by AF. PATIENTS: 120,566 patients with STEMI and NSTE-ACS in 10 clinical trials. INTERVENTIONS: None evaluated. MAIN OUTCOME MEASURE: Short- and long-term mortality. RESULTS: Occurrence of AF was 7.5% in the overall population (STEMI 8.0% (n = 84 161); NSTE-ACS = 6.4% (n = 36,405)). Seven-day mortality was higher for patients with AF (5.1%) than for those without (1.6%). After adjusting for confounders, association of AF with 7-day mortality was present in STEMI (hazards ratio (HR) = 1.65; 95% CI 1.44 to 1.90) and NSTE-ACS (HR = 2.30; 95% CI 1.83 to 2.90; p interaction = 0.015). Risk of long-term mortality (day 8 to 1 year) was also higher in STEMI (HR = 2.37; 95% CI 1.79 to 3.15) and NSTE-ACS (HR = 1.67; 95% CI 1.41 to 1.99). AF had a larger impact in NSTE-ACS on risk of short-term mortality (p<0.001), stroke (p<0.001), ischaemic stroke (p<0.001) and moderate or severe bleeding (p<0.001). CONCLUSIONS: AF is more common in patients with STEMI. An association of AF with short- and long-term mortality among patients with STEMI and NSTE-ACS was found. Understanding these findings may lead to better care of patients with this common arrhythmia. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/18332062/Short__and_long_term_outcomes_following_atrial_fibrillation_in_patients_with_acute_coronary_syndromes_with_or_without_ST_segment_elevation_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&amp;pmid=18332062 DB - PRIME DP - Unbound Medicine ER -