Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation. (1st December 2017)

• Record Type: Journal Article
• Authors: De Luca, Leonardo; Casella, Gianni; Rubboli, Andrea; Gonzini, Lucio; Lucci, Donata; Boccanelli, Alessandro; Chiarella, Francesco; Di Chiara, Antonio; De Servi, Stefano; Di Lenarda, Andrea; Di Pasquale, Giuseppe; Savonitto, Stefano
• Is Part Of: International journal of cardiology. Volume 248(2017)
• Page Start: 369
• Page End: 375
• Publication Date: 2017-12-01
• Subjects: Acute coronary syndromes -- Atrial fibrillation -- Epidemiology -- Registries; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.08.019
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: To describe the clinical characteristics, contemporary trends of in-hospital management and outcome of patients admitted for an acute coronary syndrome (ACS) with associated atrial fibrillation (AF). Methods: We analyzed data from four Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive ACS patients. Results: Out of 16, 803 ACS patients, 1019 (6.1%) presented with concomitant AF: 668 with non-ST elevation (NSTE)-ACS and 351 with ST-elevation myocardial infarction (STEMI). As compared to no-AF patients, those with AF were older and had significantly more prior cardiac events and comorbidities (all p < 0.005). A progressive increase occurred over time in the rates of coronary angiography and percutaneous coronary intervention, both in NSTE-ACS (p for trend = 0.0002 and 0.0008, respectively) and STEMI patients with AF at admission (both p for trend < 0.0001), with trends similar to those observed in non-AF patients. Among STEMI patients, in-hospital mortality decreased by 50% in those without AF (7.5% in 2001 to 3.3% in 2014, p < 0.0001), with a similar decrease in those with AF (20% vs 10.7%, p = 0.20), even though not statistically significant. At multivariable analysis, AF on admission was not an independent predictor of in-hospital mortality [odds ratio (OR): 0.82; 95% confidence intervals (CI): 0.52–1.30; p = 0.41 for NSTE-ACS, and OR: 1.07; 95% CI: 0.73–1.57; p = 0.74 for STEMI]. Conclusions: Over the last 14 years, the in-hospital management of ACS patients with AF has significantly improved as for patients without AF, with comparable effect in terms of outcome.