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Short- and Long-Term Outcomes Following Atrial Fibrillation in Patients With Acute Coronary Syndromes With or Without ST-Segment Elevation
  1. Renato D Lopes
  1. Duke Clinical Research Institute, Duke University Medical Center, United States
    1. Karen S Pieper
    1. Duke Clinical Research Institute, Duke University Medical Center, United States
      1. John R Horton
      1. Duke Clinical Research Institute, Duke University Medical Center, United States
        1. Sana M Al-Khatib
        1. Duke Clinical Research Institute, Duke University Medical Center, United States
          1. L Kristen Newby
          1. Duke Clinical Research Institute, Duke University Medical Center, United States
            1. Rajendra H Mehta
            1. Duke Clinical Research Institute, Duke University Medical Center, United States
              1. Frans Van de Werf
              1. University Hospital Gasthuisberg and Leuven Coordinating Center, Belgium
                1. Paul W Armstrong
                1. University of Alberta, Canada
                  1. Kenneth W Mahaffey
                  1. Duke Clinical Research Institute, Duke University Medical Center, United States
                    1. Robert A Harrington
                    1. Duke Clinical Research Institute, Duke University Medical Center, United States
                      1. E Magnus Ohman
                      1. Duke Clinical Research Institute, Duke University Medical Center, United States
                        1. Harvey D White
                        1. Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
                          1. Lars Wallentin
                          1. University Hospital, Sweden
                            1. Christopher B Granger (christopher.granger{at}duke.edu)
                            1. Duke Clinical Research Institute, Duke University Medical Center, United States

                              Abstract

                              Objective Assess variables associated with the occurrence of atrial fibrillation (AF) and the relation of AF with short- and long-term outcomes and with other in-hospital complications in patients with acute coronary syndromes (ACS) with and without ST-segment elevation.

                              Design Pooled database of 120,566 ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation (NSTE) ACS patients enrolled in 10 clinical trials. Multivariable logistic regression and Cox proportional hazards modeling were used to identify factors associated with AF and its relation with clinical outcomes.

                              Setting ACS complicated by AF.

                              Patients 120,566 patients with STEMI and NSTE ACS in 10 clinical trials.

                              Interventions None evaluated.

                              Main outcome measure Short- and long-term mortality.

                              Results Occurrence of AF was 7.5% in overall population (STEMI=8.0% [n=84,161]; NSTE-ACS=6.4% [n=36,405]). Seven-day mortality was higher for AF patients (5.1%) than those without (1.6%). After adjusting for confounders, association of AF with 7-day mortality was present in STEMI (HR 1.65; 95% CI, 1.44-1.90) and NSTE-ACS (HR 2.30; 95% CI 1.83-2.90; p interaction=0.015). Risk of long-term mortality (day 8-1 year) was also higher in STEMI (HR 2.37; 95% CI 1.79-3.15) and NSTE-ACS (HR 1.67; 95% CI 1.41–1.99). AF had a larger impact in NSTE-ACS on risk of: short-term mortality (p<0.001), stroke (p<0.001), ischemic stroke (p<0.001), and moderate or severe bleeding (p<0.001).

                              Conclusions AF is more common in STEMI patients. There was an association of AF with short- and long-term mortality among STEMI and NSTE-ACS patients. Understanding these findings may lead to better care of patients with this common arrhythmia.

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