Temporal trends and outcomes associated with atrial fibrillation observed during acute coronary syndrome: Real‐world data from the Acute Coronary Syndrome Israeli Survey (ACSIS), 2000–2013

Abstract

Background The past decade has brought major advances in therapy of patients presenting with acute coronary syndromes (ACS). Hypothesis The outcomes of ACS patients with atrial fibrillation (AF) has improved over the years. Methods We evaluated time‐dependent changes in clinical characteristics, management strategies, and outcomes associated with AF observed during ACS hospitalization in patients enrolled in the biannual ACS Israeli Surveys (ACSIS) between 2000 and 2013. We divided the surveys into early (2000–2006) and late (2008–2013) time periods. Results The study population comprised 13 297 ACS patients, of whom 755 (5.7%) either presented with or developed AF during the index hospitalization. The incidence of AF observed during ACS hospitalization was lower during the later period (6.2% vs 4.9%; P < 0.01). Kaplan‐Meier survival analysis showed that 1‐year mortality rates were significantly lower among ACS patients with and without AF who were enrolled during the later vs early survey period (log‐rank P < 0.01 for the overall difference). However, AF observed among ACS patients was still associated with increased risk for in‐hospital complications and 30‐day and 1‐year mortality during both the early and late survey periods (P < 0.05 for all comparisons). Conclusions In 10 years, rates of AF among ACS patients have declined significantly. Yet, despite improved overall 1‐year survival for patients with AF, the development of AF in this population remains an independent predictor of mortality that has not changed appreciably over the years.

Atrial fibrillation and risk of cardiovascular events and mortality in patients with symptomatic peripheral artery disease: A meta‐analysis of prospective studies

“…The results of our systematic review and meta‐analysis, which included high‐quality prospective cohort studies, for the first time clearly showed the increased risk of all‐cause mortality rates and MACE in patients with coexisting AF and symptomatic PAD. These findings are in line with previously published meta‐analyses on the prognostic role of AF in CAD . As warfarin and other vitamin K antagonists are known to increase vascular calcification and calcification of coronary arteries, future trials are needed to evaluate the potential benefit of direct oral anticoagulants in patients with atherosclerotic vascular disease and AF …”

“…These findings are in line with previously published meta-analyses on the prognostic role of AF in CAD. 4,5,22 As warfarin and other vitamin K antagonists are known to increase vascular calcification and calcification of coronary arteries, future trials are needed to evaluate the potential benefit of direct oral anticoagulants in patients with atherosclerotic vascular disease and AF. 23 Further prospective studies are needed to evaluate the prognostic role of AF in the whole spectrum of symptomatic and asymptomatic patients with peripheral vascular disease.…”

“…Although systematic reviews and meta‐analyses undoubtedly showed the association of AF with increased risk of mortality in patients with coronary artery disease (CAD), the prognostic implication of AF in PAD was not extensively studied. Therefore, we performed a comprehensive systematic review and meta‐analysis of available studies to assess the prognostic effect of AF to predict risk of major adverse cardiovascular events (MACE) and mortality in patients with symptomatic PAD.…”

“…2 Recently, vascular disease (including myocardial infarction [MI], aortic plaque, and PAD) was included in the CHA 2 DS 2 -VASc (congestive heart failure, HTN, age ≥ 75 years, DM, prior stroke, vascular disease, age 65-74 years, sex category) risk score, thus underlining the importance of PAD as a prognostic factor in patients with AF. 3 Although systematic reviews and meta-analyses undoubtedly showed the association of AF with increased risk of mortality in patients with coronary artery disease (CAD), 4,5 the prognostic implication of AF in PAD was not extensively studied. Therefore, we performed a comprehensive systematic review and meta-analysis of available studies to assess the prognostic effect of AF to predict risk of major adverse cardiovascular events (MACE) and mortality in patients with symptomatic PAD.…”

Antithrombotic therapy in patients with atrial fibrillation and percutaneous coronary intervention: what has changed in the guidelines in 2020?

“…Как демонстрирует один из анализов датского регистра, объединивший 11 480 больных ФП, перенесших ИМ или ЧКВ в период с 2000 по 2009 г., относительный риск кровотечений в первые 3 мес. лечения у пациентов, получавших варфарин в сочетании с аспирином и клопидогрелом, был в 1,47 раза выше, чем у пациентов, получавших аспирин и клопидогрел [3].…”