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Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis

2015; Elsevier BV; Volume: 34; Issue: 6 Linguagem: Inglês

10.1016/j.repc.2015.01.010

2174-2030

Carlos Galvão Braga, Vítor Ramos, Juliana Martins, Carina Arantes, Glória Abreu, Catarina Vieira, Alberto Salgado, António Gaspar, Pedro Azevedo, Miguel Álvares Pereira, Sónia Magalhães, Jorge Marques,

Cardiac electrophysiology and arrhythmias

Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type - new-onset (nAF) or pre-existing (pAF) - is still controversial.To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS).We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.3% male) admitted to a single center over a three-year period, with a six-month follow-up.AF rhythm was identified in 14.5% patients, of whom 71.4% presented nAF and 28.6% pAF. When AF types were compared, patients with nAF more frequently presented with ST-elevation ACS (p=0.003). Patients with pAF, in turn, were older (p=0.032), had greater left atrial diameter (p=0.001) and were less likely to have significant coronary lesions (p=0.034). Regarding therapeutic strategy, nAF patients were more often treated by rhythm control during hospital stay (p<0.001) and were less often anticoagulated at discharge (p=0.001). Compared with the population without AF, nAF was a predictor of death during hospital stay in univariate (p<0.001) and multivariate analysis (OR 2.67, p=0.047), but pAF was not. During follow-up, pAF was associated with higher mortality (p=0.014), while nAF patients presented only a trend towards worse prognosis.AF during the acute phase of ACS appears to have a negative prognostic impact only in patients with nAF and not in those with pAF.