Incidence of ischaemic stroke and mortality in patients with acute coronary syndrome and first-time detected atrial...

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• Acute coronary syndrome (ACS) is a critical cardiovascular event.
• Atrial fibrillation (AF) is a common comorbidity affecting ACS patient outcomes.
• Understanding the prognosis of newly diagnosed AF in ACS patients is crucial.

Purpose of the Study:

• To evaluate the 1-year prognosis of patients surviving ACS with newly detected atrial fibrillation.
• To compare outcomes between ACS survivors with no AF, prior AF, and first-time detected AF.
• To assess the association of first-time AF with ischemic stroke, mortality, and bleeding.

Main Methods:

• Utilized Danish nationwide registries from 2000-2018.
• Identified ACS survivors and categorized them based on AF status (none, history, first-time detected).
• Employed multivariable adjusted Cox proportional hazards analysis for outcome comparison over 1 year.

Main Results:

• Included 161,266 ACS survivors: 84.2% without AF, 11.8% with prior AF, and 4.0% with first-time detected AF.
• First-time detected AF was associated with higher adjusted 1-year rates of ischemic stroke (HR 1.67) compared to no AF.
• First-time detected AF also showed increased adjusted 1-year rates for mortality (HR 1.52) and bleeding (HR 1.28).

Conclusions:

• First-time detected AF in ACS patients carries a prognosis similar to those with a history of AF.
• Newly diagnosed AF during ACS admission is a significant risk factor for adverse outcomes.
• Clinical vigilance for first-time AF in ACS is warranted to mitigate risks of stroke, death, and bleeding.