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Published on: February 26, 2013
Outcomes of Percutaneous Coronary Intervention in Atrial Fibrillation Patients Presenting With Acute Myocardial
Madhan Shanmugasundaram1, Timir Paul2, Mehrtash Hashemzadeh3
1Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA.
Insights
Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI) have higher mortality rates. Close attention to AF patients with MI is crucial for improving outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Atrial fibrillation (AF) is a common comorbidity in patients with myocardial infarction (MI).
- Percutaneous coronary intervention (PCI) is a standard treatment for MI, but its outcomes in AF patients are not well-established.
Purpose of the Study:
- To evaluate the in-hospital mortality rates of PCI in MI patients with and without AF.
- To compare outcomes of PCI for MI between patients with and without atrial fibrillation.
Main Methods:
- Analysis of the Nationwide Inpatient Sample (NIS) database from 2002 to 2011.
- Inclusion of adult patients (over 40 years) who underwent PCI for MI.
- Comparison of age-adjusted mortality rates between AF and non-AF patient groups using ICD-9-CM codes.
Main Results:
- Over 3.2 million PCIs were analyzed, with 14.6% performed on AF patients.
- MI patients with AF were older (mean age 71.3 years) and predominantly male (60%).
- Age-adjusted in-hospital mortality following PCI for MI was significantly higher in the AF group (190.24/100,000) compared to the non-AF group (109.08/100,000).
Conclusions:
- Atrial fibrillation is prevalent in MI patients undergoing PCI.
- AF is associated with increased mortality after PCI for acute MI.
- AF is a significant risk factor in MI patients, necessitating focused management strategies to reduce mortality.
Background:
Atrial fibrillation (AF) is common in patients presenting with myocardial infarction (MI). Percutaneous coronary intervention (PCI) has been shown to improve cardiovascular outcomes in MI. However, outcomes of PCI in AF patients presenting with MI remains largely unknown.
Methods:
We analyzed the Nationwide Inpatient Sample (NIS) database to calculate the age adjusted mortality rate for PCI in AF patients presenting with MI between 2002 and 2011, in adults over 40 years of age. This was then compared to the mortality rate for PCI in non-AF patients with MI. Specific ICD-9-CM codes were used to identify patients and outcomes.
Results:
Of 3,226,405 PCIs done during the study period, 472,609 (14.6%) PCIs were done on AF patients of which 137,870 PCIs were for MI. About 60% of these patients were male. Patients with AF were older (71.3 ± 10.6 years). Overall the number of PCIs shows a declining trend from 2002 to 2011, but for MI patients the number of PCIs appears stable over the years. The age adjusted in-hospital mortality following PCI in MI was significantly higher in AF group compared to the non-AF group (190.24 ± 17.21vs 109.08 ± 5.89 per 100,000; P < 0.01). This trend was seen during the entire study period.
Conclusions:
AF is prevalent in MI patients undergoing PCI. AF is associated with increased mortality following PCI for acute MI. AF is not a benign arrhythmia in MI patients and close attention is warranted in these patients to improve mortality.
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