New-onset atrial fibrillation following STEMI was associated with increased long-term mortality (adjusted HR 1.48; 95% CI 1.20-1.82; P<.001).
Cohort (n=7,944)
Yes
Does oral anticoagulant therapy reduce long-term mortality in patients with new-onset atrial fibrillation following STEMI?
New-onset atrial fibrillation after STEMI is associated with increased long-term mortality, but treatment with oral anticoagulants in these patients is associated with improved survival.
Hazard Ratio: 1.48 (95% CI 1.2–1.82)
p-value: p=<.001
BACKGROUND: New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted. METHODS: A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes. RESULTS: Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049). CONCLUSIONS: NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.
Madsen et al. (Mon,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=7,944). New-onset atrial fibrillation (NEW-AF) vs. No new-onset atrial fibrillation was evaluated on long-term mortality (HR 1.48, 95% CI 1.20-1.82, p=<.001). New-onset atrial fibrillation following STEMI was associated with increased long-term mortality (adjusted HR 1.48; 95% CI 1.20-1.82; P<.001).