Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes

Renato D. Lopes, Jennifer A. White, Dan Atar, M. Keltai, Neal S. Kleiman, Harvey D. White, Petr Widimsky, Uwe Zeymer, Robert P. Giugliano, Pierluigi Tricoci, Eugene Braunwald, Christoph Bode, E. Magnus Ohman, Paul W. Armstrong, L. Kristin Newby

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background We assessed the incidence and timing of post-acute coronary syndrome (ACS) atrial fibrillation (AF) related and not related to coronary artery bypass grafting (CABG); described the use of antithrombotic therapy; and evaluated the association of AF with mortality. Methods We studied 9242 high-risk non-ST-segment elevation (NSTE) ACS patients enrolled in EARLY ACS. Logistic regression with a landmark approach examined the association between AF within 7 days post-ACS and 30-day death. Cox proportional hazards modeling assessed the association of AF with 1-year mortality. Results Overall, 551 patients (6.0%) had AF at a median of 4 (25th, 75th percentiles: 2, 8) days post-ACS. CABG-related AF occurred in 2.6% (N = 242) of the overall population, representing 44% of all AF episodes. At discharge, patients with AF received aspirin (87%), clopidogrel (48%), or warfarin (19%). Aspirin plus clopidogrel plus warfarin was used in 5.7% of the overall AF population and in 10.0% of patients with non-CABG-related AF. In-hospital AF within 7 days post-ACS was associated with an adjusted hazard ratio for death between 7 and 30 days of 4.83 (95% confidence interval, 3.06-7.62) as well as higher 1-year mortality (2.40 [1.90-3.03]). Conclusions Overall, AF complicated the in-hospital course of 6% of patients with NSTE ACS and was associated with substantially greater risk for 30-day and 1-year mortality. Most patients with AF did not receive oral anticoagulation at discharge, highlighting an unexplored area of antithrombotic therapy at hospital discharge in these high-risk patients.

Original languageEnglish
Pages (from-to)2510-2517
Number of pages8
JournalInternational Journal of Cardiology
Volume168
Issue number3
DOIs
Publication statusPublished - Oct 3 2013

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Acute Coronary Syndrome
Atrial Fibrillation
Incidence
clopidogrel
Mortality
Warfarin
Coronary Artery Bypass
Aspirin
Population
Arteries
Logistic Models
Confidence Intervals

Keywords

  • Antithrombotic therapy
  • Atrial fibrillation
  • Clinical outcomes
  • Non-ST-segment elevation acute coronary syndromes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes. / Lopes, Renato D.; White, Jennifer A.; Atar, Dan; Keltai, M.; Kleiman, Neal S.; White, Harvey D.; Widimsky, Petr; Zeymer, Uwe; Giugliano, Robert P.; Tricoci, Pierluigi; Braunwald, Eugene; Bode, Christoph; Ohman, E. Magnus; Armstrong, Paul W.; Newby, L. Kristin.

In: International Journal of Cardiology, Vol. 168, No. 3, 03.10.2013, p. 2510-2517.

Research output: Contribution to journalArticle

Lopes, RD, White, JA, Atar, D, Keltai, M, Kleiman, NS, White, HD, Widimsky, P, Zeymer, U, Giugliano, RP, Tricoci, P, Braunwald, E, Bode, C, Ohman, EM, Armstrong, PW & Newby, LK 2013, 'Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes', International Journal of Cardiology, vol. 168, no. 3, pp. 2510-2517. https://doi.org/10.1016/j.ijcard.2013.03.037
Lopes, Renato D. ; White, Jennifer A. ; Atar, Dan ; Keltai, M. ; Kleiman, Neal S. ; White, Harvey D. ; Widimsky, Petr ; Zeymer, Uwe ; Giugliano, Robert P. ; Tricoci, Pierluigi ; Braunwald, Eugene ; Bode, Christoph ; Ohman, E. Magnus ; Armstrong, Paul W. ; Newby, L. Kristin. / Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes. In: International Journal of Cardiology. 2013 ; Vol. 168, No. 3. pp. 2510-2517.
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AU - Lopes, Renato D.

AU - White, Jennifer A.

AU - Atar, Dan

AU - Keltai, M.

AU - Kleiman, Neal S.

AU - White, Harvey D.

AU - Widimsky, Petr

AU - Zeymer, Uwe

AU - Giugliano, Robert P.

AU - Tricoci, Pierluigi

AU - Braunwald, Eugene

AU - Bode, Christoph

AU - Ohman, E. Magnus

AU - Armstrong, Paul W.

AU - Newby, L. Kristin

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N2 - Background We assessed the incidence and timing of post-acute coronary syndrome (ACS) atrial fibrillation (AF) related and not related to coronary artery bypass grafting (CABG); described the use of antithrombotic therapy; and evaluated the association of AF with mortality. Methods We studied 9242 high-risk non-ST-segment elevation (NSTE) ACS patients enrolled in EARLY ACS. Logistic regression with a landmark approach examined the association between AF within 7 days post-ACS and 30-day death. Cox proportional hazards modeling assessed the association of AF with 1-year mortality. Results Overall, 551 patients (6.0%) had AF at a median of 4 (25th, 75th percentiles: 2, 8) days post-ACS. CABG-related AF occurred in 2.6% (N = 242) of the overall population, representing 44% of all AF episodes. At discharge, patients with AF received aspirin (87%), clopidogrel (48%), or warfarin (19%). Aspirin plus clopidogrel plus warfarin was used in 5.7% of the overall AF population and in 10.0% of patients with non-CABG-related AF. In-hospital AF within 7 days post-ACS was associated with an adjusted hazard ratio for death between 7 and 30 days of 4.83 (95% confidence interval, 3.06-7.62) as well as higher 1-year mortality (2.40 [1.90-3.03]). Conclusions Overall, AF complicated the in-hospital course of 6% of patients with NSTE ACS and was associated with substantially greater risk for 30-day and 1-year mortality. Most patients with AF did not receive oral anticoagulation at discharge, highlighting an unexplored area of antithrombotic therapy at hospital discharge in these high-risk patients.

AB - Background We assessed the incidence and timing of post-acute coronary syndrome (ACS) atrial fibrillation (AF) related and not related to coronary artery bypass grafting (CABG); described the use of antithrombotic therapy; and evaluated the association of AF with mortality. Methods We studied 9242 high-risk non-ST-segment elevation (NSTE) ACS patients enrolled in EARLY ACS. Logistic regression with a landmark approach examined the association between AF within 7 days post-ACS and 30-day death. Cox proportional hazards modeling assessed the association of AF with 1-year mortality. Results Overall, 551 patients (6.0%) had AF at a median of 4 (25th, 75th percentiles: 2, 8) days post-ACS. CABG-related AF occurred in 2.6% (N = 242) of the overall population, representing 44% of all AF episodes. At discharge, patients with AF received aspirin (87%), clopidogrel (48%), or warfarin (19%). Aspirin plus clopidogrel plus warfarin was used in 5.7% of the overall AF population and in 10.0% of patients with non-CABG-related AF. In-hospital AF within 7 days post-ACS was associated with an adjusted hazard ratio for death between 7 and 30 days of 4.83 (95% confidence interval, 3.06-7.62) as well as higher 1-year mortality (2.40 [1.90-3.03]). Conclusions Overall, AF complicated the in-hospital course of 6% of patients with NSTE ACS and was associated with substantially greater risk for 30-day and 1-year mortality. Most patients with AF did not receive oral anticoagulation at discharge, highlighting an unexplored area of antithrombotic therapy at hospital discharge in these high-risk patients.

KW - Antithrombotic therapy

KW - Atrial fibrillation

KW - Clinical outcomes

KW - Non-ST-segment elevation acute coronary syndromes

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