Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry.

Abstract

BACKGROUND::

Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear.

METHODS::

This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF.

RESULTS::

Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AF patients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AF patients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AF patients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AF patients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92).

CONCLUSIONS::

Acute coronary syndrome patients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.

• Authors: Uwe Zeymer, Lieven Annemans, Nicolas Danchin, Stuart Pocock, Simon Newsome, Frans Van de Werf, Jesús Medina, Héctor Bueno
• Journal: European heart journal. Acute cardiovascular care (Eur Heart J Acute Cardiovasc Care) Vol. 8 Issue 2 Pg. 121-129 (Mar 2019) ISSN: 2048-8734 [Electronic] England
• PMID: 29611427 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

• Fibrinolytic Agents

Topics

• Acute Coronary Syndrome (complications, mortality, surgery)
• Aged
• Atrial Fibrillation (complications, drug therapy, epidemiology)
• Cause of Death (trends)
• Europe (epidemiology)
• Female
• Fibrinolytic Agents (therapeutic use)
• Follow-Up Studies
• Humans
• Incidence
• Latin America (epidemiology)
• Male
• Middle Aged
• Percutaneous Coronary Intervention
• Prognosis
• Prospective Studies
• Registries
• Risk Factors
• Survival Rate (trends)
• Thrombolytic Therapy (methods)
• Thrombosis (epidemiology, prevention & control)
• Time Factors