Key result
De novo atrial fibrillation in acute coronary syndromes was associated with significantly higher in-hospital mortality compared to pre-existing atrial fibrillation (13.1% vs. 8.31%; P=0.0005).
Why the study?
AF increases serious adverse events including death in ACS, but whether de novo versus pre-existing AF portends different risk was unclear.
Does de novo atrial fibrillation compared to pre-existing atrial fibrillation worsen in-hospital and long-term prognosis in patients with acute coronary syndromes?
Cohort (n=2,046)
Yes
Does de novo atrial fibrillation compared to pre-existing atrial fibrillation worsen in-hospital and long-term prognosis in patients with acute coronary syndromes?
Absolute Event Rate: 13.1% vs 8.31%
p-value: p=0.0005
De novo atrial fibrillation in the setting of acute coronary syndromes is associated with significantly higher in-hospital mortality compared to pre-existing AF, highlighting the need for special attention in this high-risk subgroup.
De novo AF in ACS may warrant heightened in-hospital vigilance; leaves open whether targeted interventions improve outcomes versus pre-existing AF.
AIMS: The aim of the study was to compare in-hospital and long-term prognosis in patients with acute coronary syndromes (ACS) and de novo vs. pre-existing atrial fibrillation (AF). Atrial fibrillation increases the risk of serious adverse events including death in patients with ACS. However, it is unclear whether de novo and pre-existing AF portend a different risk. METHODS AND RESULTS: We analysed the incidence, clinical characteristics, and in-hospital and long-term outcomes in patients with AF and ACS based on combined data from Polish Registry of Acute Coronary Syndrome (PL-ACS) (n = 581 843) and SILICARD (n = 852 063) databases. Atrial fibrillation at admission was diagnosed in of 6.16% patients [de novo: 1129 (2.46%); pre-existing: 1691 (3.7%)]. Groups were compared (N = 1023 vs. 1023) after matching for relevant clinical factors. De novo and pre-existing AF differed in in-hospital diuretic (52% vs. 58%; P = 0.008) and aldosterone inhibitor (27.5% vs. 32.5%; P = 0.02) use, Thrombolysis In Myocardial Infarction (TIMI) flow before percutaneous coronary intervention (P = 0.016), and diuretic (52.1% vs. 58%; P = 0.008) and oral anticoagulant (27.5% vs. 32.5%; P = 0.018) use at discharge. In-hospital mortality in the de novo AF group was significantly higher (13.1% vs. 8.31%; P = 0.0005). Post-discharge 12-month survival was similar between groups (14.5% vs. 15.3%, P = 0.63). Long-term re-hospitalization due to heart failure (22.7% vs. 17.2%; P < 0.005) and medical contact due to AF (48.4% vs. 26.1%, P < 0.0001) rates were higher in the group with pre-existing AF, without the difference of stroke or myocardial infarction occurrence. CONCLUSION: De novo AF accounts for 40% of all AF cases in ACS patients and is an unfavourable in-hospital prognostic factor. The occurrence of de novo AF during ACS should require special attention and caution in the treatment of these patients.
No takes yet. Share an insight, caveat, or question.
Buchta et al. (2021) conducted a cohort in Acute coronary syndromes and atrial fibrillation (n=2,046). De novo atrial fibrillation vs. Pre-existing atrial fibrillation was evaluated on In-hospital mortality (p=0.0005). De novo atrial fibrillation in acute coronary syndromes was associated with significantly higher in-hospital mortality compared to pre-existing atrial fibrillation (13.1% vs. 8.31%; P=0.0005).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: