Key result
New-onset AF after first-time ACS is linked to ~73% higher 30-day mortality.
Why the study?
Although AF frequently occurs in patients presenting with ACS, the prognostic implications of new-onset AF in patients with a first-time ACS were unclear.
Does new-onset atrial fibrillation increase the risk of mortality, stroke, recurrent myocardial infarction, bleeding, and hospital readmission in patients with first-time acute coronary syndrome?
Cohort (n=139,961)
Yes
Does new-onset atrial fibrillation increase the risk of mortality, stroke, recurrent myocardial infarction, bleeding, and hospital readmission in patients with first-time acute coronary syndrome?
New-onset atrial fibrillation complicating a first acute coronary syndrome is associated with substantially higher short-term mortality and persistently elevated long-term risks of stroke, recurrent myocardial infarction, bleeding, and hospital readmission.
New-onset AF after ACS signals need for vigilant short-term monitoring; leaves open whether targeted interventions improve outcomes.
Background Atrial fibrillation (AF) frequently occurs in patients presenting with acute coronary syndrome (ACS) but the prognostic implications of new-onset AF in first-time ACS patients are unclear. Purpose To assess the association between new-onset AF after a first ACS and outcomes. Material and Methods A nationwide cohort of patients with first time ACS was identified from a registry between 2007 and 2020 and linked to national patient, death, and prescription registers. The study included 139,961 patients with first-time ACS and no prior AF. New-onset AF was defined as AF diagnosed during the index ACS hospitalization or within 30 days. Fine–Gray competing-risk models were used to estimate crude and adjusted sub distribution hazard ratios (HRs) for all-cause mortality, cardiovascular death, stroke, recurrent myocardial infarction (MI), bleeding, and hospital readmission at 30 days, 1 year, and end of follow-up. Results Among 139,961 ACS patients without prior AF, 9,291 (7%) developed new-onset AF (mean age 77 years; 64% male), while 130,670 remained AF-free (mean age 68 years; 67% male). Mean follow-up was 6.7 years. New-onset AF was associated with a substantially increased risk of all-cause mortality, with adjusted HRs of 1.73 (1.43–2.08), 1.30 (1.20–1.40) and 1.09 (1.04–1.14) at 30 days, 1 year and end of follow up respectively. The corresponding adjusted HRs for cardiovascular death were 1.50 (0.95–2.37), 1.11 (0.98–1.26) and 0.87 (0.82–0.93). Stroke risk was markedly higher nearly threefold at 30 days and remained elevated throughout follow-up (HRs 1.33–1.87). Recurrent MI risk was approximately 30% higher, and bleeding risk increased with an HR of 1.55 (1.13–2.14) at 30 days. All-cause readmissions were consistently more frequent in the new-onset AF group. Conclusions New-onset AF during ACS is associated with substantially higher short-term mortality and persistently elevated stroke risk, recurrent MI, bleeding, and hospital readmission. These patients represent a high-risk group, requiring close monitoring and optimized long term management.
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Abdi et al. (2026) conducted a cohort in First-time acute coronary syndrome without prior atrial fibrillation (n=139,961). New-onset atrial fibrillation (diagnosed during index ACS hospitalization or within 30 days) vs. Remaining atrial fibrillation-free was evaluated on All-cause mortality at 30 days (HR 1.73, 95% CI 1.43-2.08). New-onset atrial fibrillation after first-time ACS increased all-cause mortality at 30 days (HR 1.73; 95% CI 1.43-2.08), 1 year (HR 1.30), and long-term follow-up (HR 1.09).
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