Long-Term Outcomes for Patients With Acute Coronary Syndrome and Nonvalvular Atrial Fibrillation

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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Published on: February 26, 2013

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Pishoy Gouda1, Douglas C Dover2, Anamaria Savu2

  • 1Division of Cardiology, University of Alberta, Edmonton, Canada.

The American Journal of Cardiology
|January 11, 2022
PubMed

Insights

Patients with acute coronary syndrome (ACS) and a history of nonvalvular atrial fibrillation (NVAF) face worse long-term outcomes. This history significantly increases the risk of mortality, myocardial infarction, or stroke within three years.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Short-term outcomes for acute coronary syndrome (ACS) patients with nonvalvular atrial fibrillation (NVAF) are known to be poorer.
  • Long-term prognosis for this patient group remains less understood.

Purpose of the Study:

  • To investigate the long-term prognosis of patients hospitalized with ACS who have a prior history of NVAF.
  • To determine the association between a history of NVAF and adverse outcomes at 3 years post-ACS hospitalization.

Main Methods:

  • Linked administrative health databases in Alberta, Canada, to identify ACS patients (STEMI, NSTEMI, unstable angina) from 2008-2019.
  • Stratified patients based on pre-hospitalization NVAF status.
  • Utilized Cox models to assess the composite outcome of all-cause mortality, myocardial infarction, or stroke at 3 years.

Main Results:

  • 11.7% of 54,309 ACS hospitalizations involved patients with a history of NVAF.
  • Patients with prior NVAF were older, more likely female, had higher comorbidity burden, and more frequently presented with NSTEMI.
  • The 3-year composite outcome occurred in 37.0% of patients with prior NVAF versus 17.4% without (p <0.001).
  • A history of NVAF was associated with a 1.14-fold higher risk of the primary outcome, particularly for STEMI and NSTEMI.

Conclusions:

  • A history of NVAF at the time of ACS presentation is linked to a worse long-term prognosis.
  • The increased risk is significant for ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).
  • Further research may explore targeted interventions for ACS patients with NVAF.

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