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Clinical characteristics, management and outcomes of patients with acute coronary syndrome and atrial fibrillation: real-world data from two nationwide registries in Italy.
J Cardiovasc Med (Hagerstown). 2020 Feb; 21(2):99-105.JC

Abstract

BACKGROUND

Atrial fibrillation is common in the setting of acute coronary syndromes (ACS) although its impact on ACS remains controversial.

AIM

To describe in-hospital management of patients with atrial fibrillation and ACS evaluating the impact of atrial fibrillation on in-hospital and mid-term outcome.

METHODS

We analysed the data of two prospective multicentre nationwide registries (IN-ACS Outcome and MANTRA) to assess clinical characteristics, management, and outcomes of patients with ACS and atrial fibrillation. Study outcomes included death from any cause and a composite end-point of death/re-infarction/stroke/major bleeding within index admission and 6 months' follow-up.

RESULTS

Out of 12 288 ACS patients, 1236 (10.1%) had atrial fibrillation at admission or developed it during hospitalization. Atrial fibrillation patients were older, more often female, and had higher burden of comorbidities. In-hospital mortality was higher among atrial fibrillation patients (8.7 vs. 2.4%, P < 0.001). Patients with atrial fibrillation had a higher incidence of re-infarction (3.5 vs. 1.7%, P < 0.0001) and ischemic stroke (1.7 vs. 0.4%, P < 0.001) compared with those in sinus rhythm. Major bleedings were also more frequent among atrial fibrillation patients (1.9 vs. 0.9%, P < 0.001). In-hospital and at 6 months' follow-up death from any cause occurred more often in atrial fibrillation patients than in those without atrial fibrillation (9.4 vs. 3.5%, P < 0.0001). At multivariable analysis, atrial fibrillation was an independent predictor of the in-hospital composite end-point (OR 1.67, 95% CI 1.35-2.06, P < 0.0001) but not at 6 months' follow-up. The independent role of atrial fibrillation on the in-hospital composite end-point was also confirmed by propensity score analyses.

CONCLUSION

Atrial fibrillation was an independent predictor for adverse in-hospital outcome in ACS. This effect disappeared at mid-term follow-up, whereas noncardiac comorbidities emerged as prognostic factors of adverse outcomes.

Authors+Show Affiliations

Cardiology Unit, Big Metropolitan Hospital, BBM, Reggio Calabria.Division of Cardiology, Sant'Andrea Hospital, ASL 5 Liguria - La Spezia.Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona.Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona.Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo.Division of Cardiology, S. Filippo Neri Hospital, Rome.Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo.Division of Cardiology, Augusto Murri Hospital, Fermo.Division of Cardiology, S. Filippo Neri Hospital, Rome.Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome.Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31923052

Citation

Lucà, Fabiana, et al. "Clinical Characteristics, Management and Outcomes of Patients With Acute Coronary Syndrome and Atrial Fibrillation: Real-world Data From Two Nationwide Registries in Italy." Journal of Cardiovascular Medicine (Hagerstown, Md.), vol. 21, no. 2, 2020, pp. 99-105.
Lucà F, Caretta G, Vagnarelli F, et al. Clinical characteristics, management and outcomes of patients with acute coronary syndrome and atrial fibrillation: real-world data from two nationwide registries in Italy. J Cardiovasc Med (Hagerstown). 2020;21(2):99-105.
Lucà, F., Caretta, G., Vagnarelli, F., Marini, M., Iorio, A., Di Fusco, S. A., Pozzi, A., Gabrielli, D., Colivicchi, F., De Luca, L., & Gulizia, M. M. (2020). Clinical characteristics, management and outcomes of patients with acute coronary syndrome and atrial fibrillation: real-world data from two nationwide registries in Italy. Journal of Cardiovascular Medicine (Hagerstown, Md.), 21(2), 99-105. https://doi.org/10.2459/JCM.0000000000000911
Lucà F, et al. Clinical Characteristics, Management and Outcomes of Patients With Acute Coronary Syndrome and Atrial Fibrillation: Real-world Data From Two Nationwide Registries in Italy. J Cardiovasc Med (Hagerstown). 2020;21(2):99-105. PubMed PMID: 31923052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics, management and outcomes of patients with acute coronary syndrome and atrial fibrillation: real-world data from two nationwide registries in Italy. AU - Lucà,Fabiana, AU - Caretta,Giorgio, AU - Vagnarelli,Fabio, AU - Marini,Marco, AU - Iorio,Annamaria, AU - Di Fusco,Stefania Angela, AU - Pozzi,Andrea, AU - Gabrielli,Domenico, AU - Colivicchi,Furio, AU - De Luca,Leonardo, AU - Gulizia,Michele Massimo, PY - 2020/1/11/entrez PY - 2020/1/11/pubmed PY - 2020/1/11/medline SP - 99 EP - 105 JF - Journal of cardiovascular medicine (Hagerstown, Md.) JO - J Cardiovasc Med (Hagerstown) VL - 21 IS - 2 N2 - BACKGROUND: Atrial fibrillation is common in the setting of acute coronary syndromes (ACS) although its impact on ACS remains controversial. AIM: To describe in-hospital management of patients with atrial fibrillation and ACS evaluating the impact of atrial fibrillation on in-hospital and mid-term outcome. METHODS: We analysed the data of two prospective multicentre nationwide registries (IN-ACS Outcome and MANTRA) to assess clinical characteristics, management, and outcomes of patients with ACS and atrial fibrillation. Study outcomes included death from any cause and a composite end-point of death/re-infarction/stroke/major bleeding within index admission and 6 months' follow-up. RESULTS: Out of 12 288 ACS patients, 1236 (10.1%) had atrial fibrillation at admission or developed it during hospitalization. Atrial fibrillation patients were older, more often female, and had higher burden of comorbidities. In-hospital mortality was higher among atrial fibrillation patients (8.7 vs. 2.4%, P < 0.001). Patients with atrial fibrillation had a higher incidence of re-infarction (3.5 vs. 1.7%, P < 0.0001) and ischemic stroke (1.7 vs. 0.4%, P < 0.001) compared with those in sinus rhythm. Major bleedings were also more frequent among atrial fibrillation patients (1.9 vs. 0.9%, P < 0.001). In-hospital and at 6 months' follow-up death from any cause occurred more often in atrial fibrillation patients than in those without atrial fibrillation (9.4 vs. 3.5%, P < 0.0001). At multivariable analysis, atrial fibrillation was an independent predictor of the in-hospital composite end-point (OR 1.67, 95% CI 1.35-2.06, P < 0.0001) but not at 6 months' follow-up. The independent role of atrial fibrillation on the in-hospital composite end-point was also confirmed by propensity score analyses. CONCLUSION: Atrial fibrillation was an independent predictor for adverse in-hospital outcome in ACS. This effect disappeared at mid-term follow-up, whereas noncardiac comorbidities emerged as prognostic factors of adverse outcomes. SN - 1558-2035 UR - https://www.unboundmedicine.com/medline/citation/31923052/Clinical_characteristics,_management_and_outcomes_of_patients_with_acute_coronary_syndrome_and_atrial_fibrillation:_real-world_data_from_two_nationwide_registries_in_Italy L2 - https://doi.org/10.2459/JCM.0000000000000911 DB - PRIME DP - Unbound Medicine ER -
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