Nadia R Sutton1, Milan Seth1, Cyril Ruwende2, Hitinder S Gurm3. 1. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. 2. Michigan Heart, IHA, St. Joseph Mercy Hospital, Ypsilanti, Michigan. 3. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Department of Medicine, Section of Cardiology, Veterans Affairs Medical Center, Ann Arbor, Michigan. Electronic address: hgurm@med.umich.edu.
Abstract
BACKGROUND: Atrial fibrillation (AF) is increasing in prevalence, and patients with a history of AF commonly undergo percutaneous coronary intervention (PCI). There is a paucity of contemporary data on the association between AF and clinical outcomes after PCI. OBJECTIVES: The study sought to evaluate the association between AF and in-hospital adverse outcomes using a large, prospective multicenter registry. METHODS: Data for consecutive PCI cases from 47 hospitals performed between April 2011 and December 2014 were utilized for the analysis. Propensity-matched multivariate analysis was used to adjust for differences in baseline characteristics between patients with and without a history of AF. RESULTS: Of 113,283 PCI cases during the study period, a history of AF was present in 13,912 patients (12%), which varied by institution (range 2.5% to 18.4%). At baseline, patients with a history of AF were older and were more likely to have comorbid congestive heart failure, cardiomyopathy, cerebrovascular disease, and chronic lung disease. Patients with a history of AF were more likely to have in-hospital complications, including in-hospital mortality (3% vs. 1%). In propensity-matched analysis, patients with a history of AF were more likely to be treated with a bare-metal stent (27% vs. 18%). In the propensity-matched model, AF remained independently associated with an increased risk of developing post-procedural bleeding (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.15 to 1.52), heart failure (OR: 1.33; 95% CI: 1.17 to 1.52), cardiogenic shock (OR: 1.26; 95% CI: 1.08 to 1.48), and in-hospital mortality (OR: 1.41; 95% CI: 1.18 to 1.68). CONCLUSIONS: AF is common among patients undergoing PCI. AF is associated with older age, the presence of other comorbidities, and independently associated with in-hospital post-procedural heart failure, cardiogenic shock, and mortality.
BACKGROUND:Atrial fibrillation (AF) is increasing in prevalence, and patients with a history of AF commonly undergo percutaneous coronary intervention (PCI). There is a paucity of contemporary data on the association between AF and clinical outcomes after PCI. OBJECTIVES: The study sought to evaluate the association between AF and in-hospital adverse outcomes using a large, prospective multicenter registry. METHODS: Data for consecutive PCI cases from 47 hospitals performed between April 2011 and December 2014 were utilized for the analysis. Propensity-matched multivariate analysis was used to adjust for differences in baseline characteristics between patients with and without a history of AF. RESULTS: Of 113,283 PCI cases during the study period, a history of AF was present in 13,912 patients (12%), which varied by institution (range 2.5% to 18.4%). At baseline, patients with a history of AF were older and were more likely to have comorbid congestive heart failure, cardiomyopathy, cerebrovascular disease, and chronic lung disease. Patients with a history of AF were more likely to have in-hospital complications, including in-hospital mortality (3% vs. 1%). In propensity-matched analysis, patients with a history of AF were more likely to be treated with a bare-metal stent (27% vs. 18%). In the propensity-matched model, AF remained independently associated with an increased risk of developing post-procedural bleeding (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.15 to 1.52), heart failure (OR: 1.33; 95% CI: 1.17 to 1.52), cardiogenic shock (OR: 1.26; 95% CI: 1.08 to 1.48), and in-hospital mortality (OR: 1.41; 95% CI: 1.18 to 1.68). CONCLUSIONS:AF is common among patients undergoing PCI. AF is associated with older age, the presence of other comorbidities, and independently associated with in-hospital post-procedural heart failure, cardiogenic shock, and mortality.
Authors: Daniel M Alyesh; Milan Seth; David C Miller; James M Dupree; John Syrjamaki; Devraj Sukul; Simon Dixon; Eve A Kerr; Hitinder S Gurm; Brahmajee K Nallamothu Journal: Circ Cardiovasc Qual Outcomes Date: 2018-06
Authors: Charlotte Andreasen; Mads Emil Jørgensen; Gunnar H Gislason; Andreas Martinsson; Robert D Sanders; Jawdat Abdulla; Per Føge Jensen; Christian Torp-Pedersen; Lars Køber; Charlotte Andersson Journal: JAMA Cardiol Date: 2018-06-01 Impact factor: 14.676