Abstract

Lopes, R. D., White, J. A., Atar, D., Keltai, M., Kleiman, N. S., White, H. D., Widimsky, P., Zeymer, U., Giugliano, R. P., Tricoci, P., Braunwald, E., Bode, C., Ohman, E. M., Armstrong, P. W., Newby, L. K. Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes Int J Cardiol. 2013;NA(NA):NA.

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 7days 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 7days post-ACS was associated with an adjusted hazard ratio for death between 7 and 30days 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.

Trial: