Uwe Zeymer1, Lieven Annemans2, Nicolas Danchin3, Stuart Pocock4, Simon Newsome4, Frans Van de Werf5, Jesús Medina6, Héctor Bueno7,8,9. 1. 1 Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Germany. 2. 2 I-CHER Interuniversity Centre for Health Economics Research UGent, Vrije Universiteit Brussel, Belgium. 3. 3 Hôpital Européen Georges Pompidou, and René Descartes University, France. 4. 4 London School of Hygiene and Tropical Medicine, UK. 5. 5 Department of Cardiovascular Sciences, University of Leuven, Belgium. 6. 6 Medical Evidence and Observational Research, AstraZeneca, Spain. 7. 7 Centro Nacional de Investigaciones Cardiovasculares, Spain. 8. 8 Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain. 9. 9 Universidad Complutense de Madrid, Spain.
Abstract
BACKGROUND: : Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear. METHODS: : This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF. RESULTS: : Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AF patients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AF patients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AF patients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AF patients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92). CONCLUSIONS: : Acute coronary syndrome patients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.
BACKGROUND: : Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndromepatients, but impact on outcomes beyond 1 year is unclear. METHODS: : This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndromepatients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF. RESULTS: : Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AFpatients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AFpatients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AFpatients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AFpatients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92). CONCLUSIONS: : Acute coronary syndromepatients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.
Authors: Anthony P Carnicelli; Ruth Owen; Stuart J Pocock; David B Brieger; Satoshi Yasuda; Jose Carlos Nicolau; Shaun G Goodman; Mauricio G Cohen; Tabassome Simon; Dirk Westermann; Katarina Hedman; Karolina Andersson Sundell; Christopher B Granger Journal: Open Heart Date: 2021-12
Authors: Nicola Cosentino; Marco Ballarotto; Jeness Campodonico; Valentina Milazzo; Alice Bonomi; Simonetta Genovesi; Marco Moltrasio; Monica De Metrio; Mara Rubino; Fabrizio Veglia; Emilio Assanelli; Ivana Marana; Marco Grazi; Gianfranco Lauri; Antonio L Bartorelli; Giancarlo Marenzi Journal: J Clin Med Date: 2020-05-09 Impact factor: 4.241