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Published on: February 26, 2013
Prognostic impact of atrial fibrillation and atrial flutter in patients with non-ST-segment elevation acute coronary
Martín Negreira-Caamaño1, Felipe Díez-Delhoyo1, Pedro Cepas-Guillén2
1Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
Insights
New-onset atrial fibrillation/flutter (AF/AFl) in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients significantly increases in-hospital and one-year complication risks. Prior AF/AFl did not show this independent association.
Area of Science:
- Cardiology
- Clinical Medicine
- Internal Medicine
Background:
- Atrial fibrillation/flutter (AF/AFl) are common arrhythmias complicating non-ST-segment elevation acute coronary syndrome (NSTEACS).
- Understanding the prognostic impact of AF/AFl in NSTEACS is crucial for patient management.
Purpose of the Study:
- To investigate the prognostic significance of new-onset (de novo) and pre-existing atrial fibrillation/flutter (AF/AFl) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS).
Main Methods:
- Prospective, multicenter registry (IMPACT-TIMING-GO) of patients with NSTEACS undergoing invasive management.
- Patients categorized by presence of prior or de novo AF/AFl.
- Assessment of in-hospital composite endpoint (death, renal failure, ventricular arrhythmias, delirium, new infarction, mechanical complications, major bleeding) and 1-year composite endpoint (death, cardiovascular admissions, major bleeding).
Main Results:
- 1020 patients included; 7.7% had prior AF/AFl, 3.6% developed de novo AF/AFl.
- Patients with AF/AFl were older with higher comorbidity; de novo AF/AFl indicated greater clinical severity.
- De novo AF/AFl independently predicted higher in-hospital complications (OR 5.12) and 1-year adverse events (HR 1.95), unlike prior AF/AFl.
Conclusions:
- New-onset atrial fibrillation/flutter (AF/AFl) is an independent predictor of adverse outcomes in NSTEACS patients.
- This association holds for both in-hospital complications and long-term adverse events.
- Prior AF/AFl did not demonstrate an independent association with these adverse outcomes in this cohort.
Introduction And Objectives:
Arrhythmias such as atrial fibrillation and atrial flutter (AF/AFl) complicate the management of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The aim of this study was to analyze the prognostic impact of AF/AFl in this clinical setting.
Methods:
The IMPACT-TIMING-GO is a prospective, multicenter registry that enrolled patients with NSTEACS undergoing invasive management. In this subanalysis, patients were categorized based on the presence of AF/AFl (either pre-existing or occurring during admission). Clinical management and complications were assessed both during hospitalization (using a composite endpoint of death, renal failure, ventricular arrhythmias, delirium, new infarction, mechanical complications, and major bleeding) and after 1 year of follow-up (using a composite endpoint of death, cardiovascular admissions, and major bleeding).
Results:
A total of 1020 patients (mean age, 66.8±12.7 years; 23.5% women) were included. Of these, 79 (7.7%) had prior AF/AFl, and 37 (3.6%) developed de novo AF/AFl during admission. Patients with AF/AFl were older and had a higher comorbidity burden, with de novo AF/AFl being associated with greater clinical severity. After multivariate adjustment, only de novo AF/AFl, and not previous AF/AFl, was independently associated with the composite endpoint of in-hospital complications (OR, 5.12; 95%CI, 2.30-11.43; P <.001 vs OR, 1.70, 95%CI, 0.91-3.58; P=.166) and adverse events at 1 year (HR, 1.95; 95%CI, 1.02-3.76; P=.045 vs HR, 1.02, 95%CI, 0.55-5.86; P=.957).
Conclusions:
In patients with NSTEACS, de novo AF/AFl is independently associated with higher rates of both in-hospital and follow-up complications.
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