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Prognostic impact of types of atrial fibrillation in acute coronary syndromes.
Am J Cardiol. 2009 Nov 15; 104(10):1317-23.AJ

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.

Authors+Show Affiliations

Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and Disciplines of Medicine and Physiology, University of Adelaide, Adelaide, South Australia, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19892044

Citation

Lau, Dennis H., et al. "Prognostic Impact of Types of Atrial Fibrillation in Acute Coronary Syndromes." The American Journal of Cardiology, vol. 104, no. 10, 2009, pp. 1317-23.
Lau DH, Huynh LT, Chew DP, et al. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. Am J Cardiol. 2009;104(10):1317-23.
Lau, D. H., Huynh, L. T., Chew, D. P., Astley, C. M., Soman, A., & Sanders, P. (2009). Prognostic impact of types of atrial fibrillation in acute coronary syndromes. The American Journal of Cardiology, 104(10), 1317-23. https://doi.org/10.1016/j.amjcard.2009.06.055
Lau DH, et al. Prognostic Impact of Types of Atrial Fibrillation in Acute Coronary Syndromes. Am J Cardiol. 2009 Nov 15;104(10):1317-23. PubMed PMID: 19892044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic impact of types of atrial fibrillation in acute coronary syndromes. AU - Lau,Dennis H, AU - Huynh,Luan T, AU - Chew,Derek P, AU - Astley,Carolyn M, AU - Soman,Ashish, AU - Sanders,Prashanthan, Y1 - 2009/09/25/ PY - 2009/03/19/received PY - 2009/06/19/revised PY - 2009/06/19/accepted PY - 2009/11/7/entrez PY - 2009/11/7/pubmed PY - 2009/12/16/medline SP - 1317 EP - 23 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 104 IS - 10 N2 - 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. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/19892044/Prognostic_impact_of_types_of_atrial_fibrillation_in_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(09)01317-4 DB - PRIME DP - Unbound Medicine ER -