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Vol. 72. Issue 5.
Pages 383-391 (May 2019)
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Vol. 72. Issue 5.
Pages 383-391 (May 2019)
Original article
DOI: 10.1016/j.rec.2018.03.002
New-onset or Pre-existing Atrial Fibrillation in Acute Coronary Syndromes: Two Distinct Phenomena With a Similar Prognosis
La fibrilación auricular de nueva aparición o preexistente en los síndromes coronarios agudos: dos fenómenos distintos con un pronóstico comparable
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Luigi Biascoa, Dragana Radovanovicb, Marco Moccettia, Hans Ricklic, Marco Roffid, Franz Eberlie, Raban Jegerf, Tiziano Moccettia, Paul Erneg, Giovanni Pedrazzinia,
Corresponding author
giovanni.pedrazzini@cardiocentro.org

Corresponding author: Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland.
a Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
b AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
c Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
d Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland
e Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland
f Division of Cardiology, University Hospital Basel, Basel, Switzerland
g AMIS Plus, Zurich and Department of Biomedicine, University of Basel, Basel, Switzerland
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Tables (4)
Table 1. Baseline Clinical Characteristics
Table 2. In-hospital Acute Treatments and Discharge Therapies
Table 3. In-hospital and 1-year Outcome
Table 4. Independent Predictors of In-hospital Mortality in Acute Coronary Syndrome Patients
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Abstract
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.

Keywords:
Atrial fibrillation
Acute coronary syndrome
ST-segment elevation myocardial infarction
Mortality
Abbreviations:
ACS
AF
New-AF
PCI
Pre-AF
Resumen
Introducción y objetivos

El tratamiento y la estratificación del riesgo de los pacientes con fibrilación auricular (FA) y síndromes coronarios agudos son todo un reto. El objetivo es evaluar el impacto pronóstico de la FA, ya sea al ingreso como la aparecida durante la hospitalización por síndrome coronario agudo, así como las tendencias en los tratamientos y el resultado.

Métodos

Se analizaron retrospectivamente los datos procedentes de 35.958 pacientes incluidos entre 2004 y 2015 en el registro AMIS Plus.

Resultados

Había FA preexistente (FApre) en 1.644 pacientes (4,7%), mientras que se evidenció FA de nueva aparición (FAnueva) en 309 (0,8%). La presentación con infarto agudo de miocardio con elevación del segmento ST y la necesidad de asistencia hemodinámica fueron frecuentes en los pacientes con FA, especialmente aquellos con FA nueva. Se observó un cambio en los enfoques médicos e intervencionistas, con un progresivo aumento de la prescripción de anticoagulación oral y las derivaciones para angiografías e intervenciones coronarias percutáneas de pacientes con FApre. A pesar de los diferentes perfiles de riesgo iniciales y presentaciones clínicas, ambos grupos de FA mostraron grandes y comparables mortalidades hospitalaria y a 1 año (FAnueva frente a FApre: mortalidad hospitalaria, OR = 0,79; IC95%, 0,53-1,17; p = 0,246; mortalidad a 1 año, OR = 0,72; IC95%, 0,31-1,67; p = 0,448). La FApre, pero no la FAnueva, predijo de manera independiente la mortalidad hospitalaria. Si bien la mortalidad de aquellos con FApre disminuyó durante el periodo de estudio, se mantuvo estable entre los pacientes con FAnueva.

Conclusiones

Mientras que la FApre se asocia de manera independiente con la mortalidad hospitalaria, la FA nueva puede reflejar un peor impacto hemodinámico del síndrome coronario agudo, lo que en última instancia determina el pronóstico.

Palabras clave:
Fibrilación auricular
Síndrome coronario agudo
Infarto agudo de miocardio con elevación del segmento ST
Mortalidad

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