Kuan-Jen Su1,2, Wen-Yu Lin1, Wei-Shiang Lin1, Chin-Sheng Lin1, Cheng-Chung Cheng1, Jun-Ting Liou1, Chen-Hsuan Ho3, Shih-Ping Yang1, Shu-Meng Cheng1, Yuan Hung1. 1. Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 2. Division of Cardiology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan. 3. Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Abstract
BACKGROUND: New-onset atrial fibrillation (NOAF) in acute coronary syndrome (ACS) may be associated with a poor prognosis. However, whether restoring sinus rhythm (SR) at discharge in patients with ACS improves outcomes remains unknown. METHODS: A total of 552 patients with ACS at an emergency department during 2011-2016 were enrolled. According to documented electrocardiography at admission and medical records, the patients were classified into without atrial fibrillation (WAF), NOAF, and prior atrial fibrillation (PAF) groups. Major adverse events (MAEs) were defined as cardiac death, recurrent myocardial infarction, heart failure requiring hospitalization, target lesion revascularization, and stroke. The mean follow-up period of MAEs was 25 ± 15 months. RESULTS: Compared with the NOAF and PAF groups, the WAF group was younger and had a significantly lower heart rate, prior stroke rate, CHA2DS2-VASc score, and lower Global Registry of Acute Coronary Events (GRACE) score in the emergency department (p < 0.001). The patients in the NOAF group had the highest incidence of MAEs (p < 0.001) during follow-up, and those whose SR was restored at discharge had a lower MAE rate than those with AF at discharge (p = 0.001). In multivariable analysis, prior myocardial infarction, GRACE score, use of beta-blockers, and restoring SR at discharge were independent predictors of MAEs in the NOAF group. CONCLUSIONS: The patients with ACS who presented with NOAF had worse outcomes than those with PAF or WAF. The patients with NOAF whose rhythm was restored to SR at discharge were associated with better outcomes than those with AF at discharge.
BACKGROUND: New-onset atrial fibrillation (NOAF) in acute coronary syndrome (ACS) may be associated with a poor prognosis. However, whether restoring sinus rhythm (SR) at discharge in patients with ACS improves outcomes remains unknown. METHODS: A total of 552 patients with ACS at an emergency department during 2011-2016 were enrolled. According to documented electrocardiography at admission and medical records, the patients were classified into without atrial fibrillation (WAF), NOAF, and prior atrial fibrillation (PAF) groups. Major adverse events (MAEs) were defined as cardiac death, recurrent myocardial infarction, heart failure requiring hospitalization, target lesion revascularization, and stroke. The mean follow-up period of MAEs was 25 ± 15 months. RESULTS: Compared with the NOAF and PAF groups, the WAF group was younger and had a significantly lower heart rate, prior stroke rate, CHA2DS2-VASc score, and lower Global Registry of Acute Coronary Events (GRACE) score in the emergency department (p < 0.001). The patients in the NOAF group had the highest incidence of MAEs (p < 0.001) during follow-up, and those whose SR was restored at discharge had a lower MAE rate than those with AF at discharge (p = 0.001). In multivariable analysis, prior myocardial infarction, GRACE score, use of beta-blockers, and restoring SR at discharge were independent predictors of MAEs in the NOAF group. CONCLUSIONS: The patients with ACS who presented with NOAF had worse outcomes than those with PAF or WAF. The patients with NOAF whose rhythm was restored to SR at discharge were associated with better outcomes than those with AF at discharge.
Authors: S S Rathore; A K Berger; K P Weinfurt; K A Schulman; W J Oetgen; B J Gersh; A J Solomon Journal: Circulation Date: 2000-03-07 Impact factor: 29.690
Authors: Craig T January; L Samuel Wann; Joseph S Alpert; Hugh Calkins; Joaquin E Cigarroa; Joseph C Cleveland; Jamie B Conti; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Katherine T Murray; Ralph L Sacco; William G Stevenson; Patrick J Tchou; Cynthia M Tracy; Clyde W Yancy Journal: J Am Coll Cardiol Date: 2014-03-28 Impact factor: 24.094
Authors: Paulus Kirchhof; Stefano Benussi; Dipak Kotecha; Anders Ahlsson; Dan Atar; Barbara Casadei; Manuel Castella; Hans-Christoph Diener; Hein Heidbuchel; Jeroen Hendriks; Gerhard Hindricks; Antonis S Manolis; Jonas Oldgren; Bogdan Alexandru Popescu; Ulrich Schotten; Bart Van Putte; Panagiotis Vardas; Stefan Agewall; John Camm; Gonzalo Baron Esquivias; Werner Budts; Scipione Carerj; Filip Casselman; Antonio Coca; Raffaele De Caterina; Spiridon Deftereos; Dobromir Dobrev; José M Ferro; Gerasimos Filippatos; Donna Fitzsimons; Bulent Gorenek; Maxine Guenoun; Stefan H Hohnloser; Philippe Kolh; Gregory Y H Lip; Athanasios Manolis; John McMurray; Piotr Ponikowski; Raphael Rosenhek; Frank Ruschitzka; Irina Savelieva; Sanjay Sharma; Piotr Suwalski; Juan Luis Tamargo; Clare J Taylor; Isabelle C Van Gelder; Adriaan A Voors; Stephan Windecker; Jose Luis Zamorano; Katja Zeppenfeld Journal: Europace Date: 2016-08-27 Impact factor: 5.214
Authors: Lars Køber; Karl Swedberg; John J V McMurray; Marc A Pfeffer; Eric J Velazquez; Rafael Diaz; Aldo P Maggioni; Viatcheslav Mareev; Grzegorz Opolski; Frans Van de Werf; Faiez Zannad; Georg Ertl; Scott D Solomon; Steven Zelenkofske; Jean-Lucien Rouleau; Jeffrey D Leimberger; Robert M Califf Journal: Eur J Heart Fail Date: 2006-02-28 Impact factor: 15.534
Authors: Kent R Nilsson; Sana M Al-Khatib; Yi Zhou; Karen Pieper; Harvey D White; Aldo P Maggioni; Lars Kober; Christopher B Granger; Eldrin F Lewis; John J V McMurray; Robert M Califf; Eric J Velazquez Journal: Heart Date: 2010-04-20 Impact factor: 5.994
Authors: G E Kochiadakis; E I Skalidis; M D Kalebubas; N E Igoumenidis; S I Chrysostomakis; E M Kanoupakis; E N Simantirakis; P E Vardas Journal: Eur Heart J Date: 2002-05 Impact factor: 29.983