Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction - 19/06/21
, Mia Ravn Jacobsen, MD a, 1, Muhammad Sabbah, MD a, Divan Gabriel Topal, MD, PhD a, Reza Jabbari, MD, PhD a, Charlotte Glinge, MD, PhD a, Lars Køber, MD, DMSc a, Christian Torp-Pedersen, MD, DMSc b, c, Frants Pedersen, MD, PhD a, Rikke Sørensen, MD, PhD a, Lene Holmvang, MD, DMSc a, Thomas Engstrøm, MD, DMSc a, d, 2, Jacob Thomsen Lønborg, MD, DMSc a, 2Highlights |
• | Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF within 30 days of STEMI. |
• | NEW-AF following STEMI was associated with poor long-term prognostic outcomes. |
• | OAC therapy in NEW-AF patients was associated with reduced long-term mortality. |
• | NEW-AF patients may benefit from OAC in addition to usual antithrombotic treatment |
• | Future monitoring of NEW-AF patients after STEMI is pivotal to improve prognosis |
Riassunto |
Background |
New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted.
Methods |
A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes.
Results |
Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049).
Conclusions |
NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.
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Vol 238
P. 89-99 - Agosto 2021 Ritorno al numero
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