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Rigshospitalet - a part of Copenhagen University Hospital
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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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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.

Original languageEnglish
JournalAmerican Heart Journal
Volume238
Pages (from-to)89-99
Number of pages11
ISSN0002-8703
DOIs
Publication statusPublished - Aug 2021

Bibliographical note

Copyright © 2021 Elsevier Inc. All rights reserved.

    Research areas

  • 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

ID: 68134891