• NEWS . 07 Feb 2020
  • Atrial fibrillation is an independent predictor for adverse in-hospital outcome in ACS

  • A study in Italy has shown atrial fibrillation is an independent predictor for adverse in-hospital outcome in acute coronary syndrome (ACS), but this effect disappeared at 6 months’ follow-up, whereas non-cardiac comorbidities emerged as prognostic factors of adverse outcomes.

    The researchers analysed the data of two prospective multicentre nationwide registries (IN-ACS Outcome and MANTRA) to assess clinical characteristics, management and outcomes of patients with ACS and atrial fibrillation. Study outcomes included death from any cause and a composite endpoint of death, re-infarction, stroke, major bleeding within index admission and 6 months' follow-up.

    Of 12,288 ACS patients, 1,236 (10.1%) had atrial fibrillation at admission or developed it during hospitalization. Atrial fibrillation patients were older, more often female and had a higher burden of comorbidities. In-hospital mortality was higher among atrial fibrillation patients (8.7% vs 2.4%; p < 0.001). Patients with atrial fibrillation had a higher incidence of re-infarction (3.5% vs 1.7%; p < 0.0001) and ischaemic stroke (1.7% vs 0.4%; p< 0.001) compared with those in sinus rhythm.

    Major bleeding events were also more frequent among atrial fibrillation patients (1.9% vs 0.9%; p < 0.001). In-hospital and at 6-month follow-up death from any cause occurred more often in atrial fibrillation patients than in those without atrial fibrillation (9.4% vs 3.5%; p < 0.0001). At multivariable analysis, atrial fibrillation was an independent predictor of the in-hospital composite endpoint (odds ratio, 1.67; 95% confidence interval, 1.35–2.06; p < 0.0001) but not at 6 months' follow-up.

    Therefore, atrial fibrillation could be an important cause of worse outcome during hospitalization for ACS, although its prognostic role after discharge is probably less
    strong.

    Reference:
    Lucà F, et al. Clinical characteristics, management and outcomes of patients with acute coronary syndrome and atrial fibrillation: real-world data from two nationwide registries in Italy. J Cardiovasc Med (Hagerstown) 2020;21:99-105.