- 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
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.