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Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction

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@article{23168bf44e8a4076af24760989ec9d5a,
title = "Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction",
abstract = "BACKGROUND: New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted.METHODS: A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes.RESULTS: Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049).CONCLUSIONS: NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.",
keywords = "Administration, Oral, Aged, Anticoagulants/administration & dosage, Atrial Fibrillation/diagnosis, Cohort Studies, Denmark/epidemiology, Female, Hemorrhage/chemically induced, Humans, Incidence, Ischemic Stroke/epidemiology, Male, Middle Aged, Multimorbidity, Multivariate Analysis, Percutaneous Coronary Intervention, Prognosis, Recurrence, Registries, Retrospective Studies, ST Elevation Myocardial Infarction/complications, Time Factors, Treatment Outcome",
author = "Madsen, {Jasmine Melissa} and Jacobsen, {Mia Ravn} and Muhammad Sabbah and Topal, {Divan Gabriel} and Reza Jabbari and Charlotte Glinge and Lars K{\o}ber and Christian Torp-Pedersen and Frants Pedersen and Rikke S{\o}rensen and Lene Holmvang and Thomas Engstr{\o}m and L{\o}nborg, {Jacob Thomsen}",
note = "Copyright {\textcopyright} 2021 Elsevier Inc. All rights reserved.",
year = "2021",
month = aug,
doi = "10.1016/j.ahj.2021.04.012",
language = "English",
volume = "238",
pages = "89--99",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby, Inc",

}

RIS

TY - JOUR

T1 - Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction

AU - Madsen, Jasmine Melissa

AU - Jacobsen, Mia Ravn

AU - Sabbah, Muhammad

AU - Topal, Divan Gabriel

AU - Jabbari, Reza

AU - Glinge, Charlotte

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Pedersen, Frants

AU - Sørensen, Rikke

AU - Holmvang, Lene

AU - Engstrøm, Thomas

AU - Lønborg, Jacob Thomsen

N1 - Copyright © 2021 Elsevier Inc. All rights reserved.

PY - 2021/8

Y1 - 2021/8

N2 - BACKGROUND: New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted.METHODS: A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes.RESULTS: Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049).CONCLUSIONS: NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.

AB - BACKGROUND: New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted.METHODS: A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes.RESULTS: Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049).CONCLUSIONS: NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.

KW - Administration, Oral

KW - Aged

KW - Anticoagulants/administration & dosage

KW - Atrial Fibrillation/diagnosis

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Female

KW - Hemorrhage/chemically induced

KW - Humans

KW - Incidence

KW - Ischemic Stroke/epidemiology

KW - Male

KW - Middle Aged

KW - Multimorbidity

KW - Multivariate Analysis

KW - Percutaneous Coronary Intervention

KW - Prognosis

KW - Recurrence

KW - Registries

KW - Retrospective Studies

KW - ST Elevation Myocardial Infarction/complications

KW - Time Factors

KW - Treatment Outcome

UR - http://www.scopus.com/inward/record.url?scp=85107452490&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2021.04.012

DO - 10.1016/j.ahj.2021.04.012

M3 - Journal article

C2 - 33957102

VL - 238

SP - 89

EP - 99

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

ER -

ID: 68134891