Impact of chronic atrial fibrillation on outcomes of acute pulmonary embolism in pancreatic cancer patients.

e16368 Background: Chronic atrial fibrillation increases thromboembolic risk and may worsen outcomes in acute pulmonary embolism. Pancreatic cancer patients face elevated thrombotic risk, yet the impact of chronic atrial fibrillation in this population remains poorly characterized. This retrospective study evaluated the association between chronic atrial fibrillation and clinical outcomes in pancreatic cancer patients hospitalized with acute pulmonary embolism. Methods: We evaluated adult patients with pancreatic cancer hospitalized for acute pulmonary embolism. Patients were stratified by the presence or absence of chronic atrial fibrillation. Baseline demographic and clinical characteristics were compared between groups. Multivariable logistic regression models were used to assess the independent association between chronic atrial fibrillation and clinical outcomes, adjusting for relevant confounders including age, comorbidity burden, and other baseline characteristics. Results: Among 13,095 pancreatic cancer patients hospitalized with acute pulmonary embolism, 195 (1.49%) had chronic atrial fibrillation. Patients with chronic atrial fibrillation were significantly older (74.79 vs 67.83 years, p < 0.001), had higher comorbidity burden (Charlson Comorbidity Index 6.97 vs 6.20, p = 0.032), and longer hospital stays (6.79 vs 4.86 days, p = 0.013). After multivariable adjustment, chronic atrial fibrillation was independently associated with increased odds of acute kidney injury (aOR 2.775, 95% CI 1.366–5.637, p = 0.005). No significant differences were observed in in-hospital mortality (aOR 1.570, 95% CI 0.520–4.737, p = 0.423), catheter-directed thrombolysis (aOR 2.943, 95% CI 0.366–23.683, p = 0.310), blood transfusion (aOR 1.009, 95% CI 0.239–4.249, p = 0.991), vasopressor use (aOR 4.443, 95% CI 0.527–37.461, p = 0.170), mechanical ventilation (aOR 1.437, 95% CI 0.190–10.836, p = 0.725), cardiac arrest (aOR 1.614, 95% CI 0.212–12.310, p = 0.644), shock (aOR 2.790, 95% CI 0.637–12.214, p = 0.173), acute encephalopathy (aOR 1.599, 95% CI 0.365–7.010, p = 0.533), intracranial hemorrhage (aOR 7.305, 95% CI 0.868–61.445, p = 0.067), gastrointestinal bleeding (aOR 1.738, 95% CI 0.488–6.183, p = 0.393), mechanical thrombectomy (aOR 1.492, 95% CI 0.186–11.995, p = 0.707), sepsis (aOR 1.726, 95% CI 0.404–7.374, p = 0.461), major bleeding (aOR 1.522, 95% CI 0.808–2.867, p = 0.193), or intensive care unit admission (aOR 0.840, 95% CI 0.114–6.216, p = 0.864). Conclusions: In pancreatic cancer patients hospitalized with acute pulmonary embolism, chronic atrial fibrillation was independently associated with increased risk of acute kidney injury but not with other cardiovascular complications or in-hospital mortality. Further research is needed to evaluate long-term outcomes in this high-risk population.