Prognostic impact of atrial fibrillation in acute coronary syndromes: results from the ARIAM registry

Abstract

These findings suggest that the presence of new-onset AF during ACS is associated with a significant increase in mortality, even after adjusting for confounding variables.

Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients

“…10,11) In previous studies, patients with permanent AF or new onset AF had higher rates of CV mortality as well as readmission for HF in AMI, irrespective of STEMI or NSTEMI. [9][10][11] Patients with AF often have multiple comorbidities, for example, older age, small body weight, hypertension, left ventricular hypertrophy, and/or ventricular systolic dysfunction. 26) With these clinical characteristics, AF patients are vulnerable to HF and cardiogenic shock in the initial phase of AMI, and suffer prevalent events of bleeding and major arterial embolism during the chronic phase of MI.…”

“…Several clinical reports, such as the HORIZONS-AMI study, 10) have reminded us of the importance of AF in AMI or STEMI populations. However, these data had some limitations, such as relatively advanced age, 8) mixed population of ACS, 9) and only including new onset AF that occurred after primary PCI. 10,11) To overcome these limitations, we selected STEMI patients who arrived at the ER within 12 hours after chest pain onset and underwent primary PCI within 90 minutes after ER arrival from the KAMIR database to reflect the real situation of modern treatment modalities for STEMI.…”

“…7) AF patients undergoing PCI usually have more major adverse cardiac events compared to patients with normal sinus rhythm (NSR). 8) The ARIAM registry showed higher inhospital mortality in new onset AF compared to NSR or previously existing AF in acute coronary syndrome (ACS), 9) and new onset AF was one of the important predictors of mortality, and non-coronary artery bypass graft (CABG) related major bleeding in ST-segment elevation myocardial infarction (STE-MI) underwent primary PCI in HORIZON-AMI study.…”

Prognostic Impact of Clopidogrel Pretreatment in Patients With Acute Coronary Syndrome Managed Invasively

“…The particularities of this registry have been previously described. [16] In brief, demographic, laboratory, and angiographic variables and occurrence of clinical events during the hospital course were collected from patients with definitive diagnosis of ACS admitted to Coronary Care Units of 49 centers through an online platform (www.ariam-andalucia.org). Patients with ACS in whom an invasive approach (coronary angiography) was performed during admission M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 and who received clopidogrel constituted the study population.…”

Transient Atrial Fibrillation During Acute Myocardial Infarction Is a Predictor of Poor Outcomes

“…7 Of note, according to the ARIAM Andalucia Study, the propensity score analysis revealed that only new-onset AF persisted as an independent predictor for death, and that MACE were more frequent in new-onset AF than in previous AF or non-AF patients. 8 In patients with chronic heart failure, only new-onset AF was also associated with increased death (hazard ratio 1.72), but not paroxysmal or chronic AF. 9 More recently, Batra et al in the Swedish registry study reported that AF was associated with a higher risk of MACE than sinus rhythm, irrespective of AF type (paroxysmal, persistent, chronic).…”