Leonardo De Luca1, Gianni Casella2, Andrea Rubboli2, Lucio Gonzini3, Donata Lucci3, Alessandro Boccanelli4, Francesco Chiarella5, Antonio Di Chiara6, Stefano De Servi7, Andrea Di Lenarda8, Giuseppe Di Pasquale2, Stefano Savonitto9. 1. Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli, Rome, Italy. 2. Department of Cardiology, Maggiore Hospital, Bologna, Italy. 3. ANMCO Research Center, Florence, Italy. 4. Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Rome, Italy. 5. Division of Cardiology, Azienda Ospedaliera-Universitaria S. Martino, Genova, Italy. 6. Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo, Italy. 7. Division of Cardiology, IRCCS Multimedica, Sesto San Giovanni, Milano, Italy. 8. Division of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Italy. 9. Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy. Electronic address: centrostudi@anmco.it.
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 14years, the in-hospital management of ACS patients with AF has significantly improved as for patients without AF, with comparable effect in terms of outcome.
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-AFpatients, 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-AFpatients. 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 14years, the in-hospital management of ACS patients with AF has significantly improved as for patients without AF, with comparable effect in terms of outcome.
Authors: Eero Anttonen; Olli Punkka; Joonas Leivo; Sanjit S Jolly; Vladimír Džavík; Jyri Koivumäki; Minna Tahvanainen; Kimmo Koivula; Kjell Nikus; Jia Wang; John A Cairns; Kari Niemelä; Markku Eskola Journal: CJC Open Date: 2021-06-04