De novo and pre-existing atrial fibrillation in acute coronary syndromes: impact on prognosis and cardiovascular events in long-term follow-up
De novo and pre-existing atrial fibrillation in acute coronary syndromes: impact on prognosis and cardiovascular events in long-term follow-up
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DOI：
10.1093/ehjacc/zuab091
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发表时间：
2021-10-30
影响因子：
4.1
通讯作者：
Gasior, Mariusz
中科院分区：
文献类型：
--
作者：
Buchta, Piotr;Kalarus, Zbigniew;Gasior, Mariusz
目的比较急性冠脉综合征(ACS)伴新发房颤(AF)患者与既往房颤患者的住院和长期预后。房颤增加了急性冠脉综合征患者发生严重不良事件的风险，包括死亡。方法和结果基于波兰急性冠脉综合征登记处(PL-ACS)(n=581843)和SILICARD(n=852063)数据库的联合数据，我们分析了房颤和急性冠脉综合征患者的发病率、临床特征、住院和长期预后。入院时诊断为房颤的患者占6.16%[初诊：1129例(2.46%)；既往：1691例(3.7%)]。在匹配相关临床因素后进行组间比较(N=1023比1023)。在住院期间利尿剂(52%比58%；P=0.008)和醛固酮抑制剂(27.5%比32.5%；P=0.02)使用、经皮冠状动脉介入治疗前心肌梗死(P=0.016)血流中溶栓(P=0.016)、出院时利尿剂(52.1%比58%；P=0.008)和口服抗凝剂(27.5%比32.5%；P=0.018)。房颤组的住院死亡率显著高于对照组(13.1%vs.8.31%；P=0.0005)。两组患者出院后12个月生存率相似(14.5%vs.15.3%，P=0.63)。既往房颤患者因心力衰竭(22.7%比17.2%；P<；0.005)和因房颤(48.4%比26.1%，P<；0.0001)而长期再住院率较高，而卒中或心肌梗死的发生率无明显差异。在急性冠脉综合征患者的治疗中，新发房颤的发生需要特别注意和谨慎。
Aims The aim of the study was to compare in-hospital and long-term prognosis in patients with acute coronary syndromes (ACS) and de novo vs. pre-existing atrial fibrillation (AF). Atrial fibrillation increases the risk of serious adverse events including death in patients with ACS. However, it is unclear whether de novo and pre-existing AF portend a different risk.Methods and results We analysed the incidence, clinical characteristics, and in-hospital and long-term outcomes in patients with AF and ACS based on combined data from Polish Registry of Acute Coronary Syndrome (PL-ACS) (n = 581 843) and SILICARD (n = 852 063) databases. Atrial fibrillation at admission was diagnosed in of 6.16% patients [de novo: 1129 (2.46%); pre-existing: 1691 (3.7%)]. Groups were compared (N= 1023 vs. 1023) after matching for relevant clinical factors. De novo and pre-existing AF differed in in-hospital diuretic (52% vs. 58%; P = 0.008) and aldosterone inhibitor (27.5% vs. 32.5%; P = 0.02) use, Thrombolysis In Myocardial Infarction (TIMI) flow before percutaneous coronary intervention (P = 0.016), and diuretic (52.1% vs. 58%; P = 0.008) and oral anticoagulant (27.5% vs. 32.5%; P = 0.018) use at discharge. In-hospital mortality in the de novo AF group was significantly higher (13.1% vs. 8.31%; P = 0.0005). Post-discharge 12-month survival was similar between groups (14.5% vs. 15.3%, P = 0.63). Long-term re-hospitalization due to heart failure (22.7% vs. 17.2%; P < 0.005) and medical contact due to AF (48.4% vs. 26.1%, P < 0.0001) rates were higher in the group with pre-existing AF, without the difference of stroke or myocardial infarction occurrence.Conclusion De novo AF accounts for 40% of all AF cases in ACS patients and is an unfavourable in-hospital prognostic factor. The occurrence of de novo AF during ACS should require special attention and caution in the treatment of these patients.