Key result
New-onset atrial fibrillation in patients with acute pulmonary embolism was associated with higher adverse in-hospital outcomes (10.4% vs 2.6%, p=0.02) but was not an independent predictor.
Why the study?
Atrial fibrillation can be secondary to acute pulmonary embolism, and its prognostic impact in these patients needed investigation.
Does new-onset atrial fibrillation predict adverse in-hospital outcomes in patients with acute pulmonary embolism?
Case-Control (n=231)
Does new-onset atrial fibrillation predict adverse in-hospital outcomes in patients with acute pulmonary embolism?
Absolute Event Rate: 10.4% vs 2.6%
p-value: p=0.02
New-onset atrial fibrillation in acute pulmonary embolism is associated with higher unadjusted rates of adverse in-hospital outcomes but is not an independent predictor when adjusting for sPESI.
New-onset AF signals higher unadjusted in-hospital risk in acute PE; leaves open independent prognostic value beyond sPESI.
Atrial fibrillation (AF) can be secondary to acute pulmonary embolism (PE). This study aimed to investigate the prognostic impact of new-onset AF on patients with acute PE. In this study, 4,288 consecutive patients who were diagnosed with acute PE were retrospectively screened. In total, 77 patients with acute PE and new-onset AF were analyzed. Another 154 acute PE patients without AF were selected as the age- and sex-matched control group. Adverse in-hospital outcome comprised one of the following conditions: all-cause death, endotracheal intubation, cardiopulmonary resuscitation, and intravenous catecholamine therapy. The patients with new-onset AF had higher prevalence of congestive heart failure, higher simplified PE severity index (sPESI), higher creatinine, and larger left atrium diameter. The incidences of adverse in-hospital outcomes were 10.4 and 2.6% in patients with new-onset AF and no AF, respectively (p = 0.02). Patients with sPESI ≥ 1 had higher incidence of adverse in-hospital outcomes than those with sPESI = 0 (9.4 vs. 0.9%, p < 0.01). The area under the receiver operating characteristic curve of sPESI and sPESI + AF (adding 1 point for new-onset AF) scores in assessing the adverse in-hospital outcome were 0.80 (95% confidence interval [CI]: 0.68–0.93) and 0.84 (95% CI: 0.72–0.96), respectively. In multivariable analysis, sPESI ≥ 1 (odds ratio, 8.88; 95% CI: 1.10–72.07; p = 0.04) was an independent predictor of adverse in-hospital outcome. However, new-onset AF was not an independent predictor. In the population studied, sPESI is an independent predictor of adverse in-hospital outcomes, whereas new-onset AF following acute PE is not, but it may add predictive value to sPESI.
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Jing et al. (2020) conducted a case-control in Acute pulmonary embolism (n=231). New-onset atrial fibrillation vs. No atrial fibrillation was evaluated on Adverse in-hospital outcome (all-cause death, endotracheal intubation, cardiopulmonary resuscitation, and intravenous catecholamine therapy) (p=0.02). New-onset atrial fibrillation in patients with acute pulmonary embolism was associated with higher adverse in-hospital outcomes (10.4% vs 2.6%, p=0.02) but was not an independent predictor.
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