Abstract
Background
We assessed the incidence and timing of post-acute coronary syndrome (ACS) atrial
fibrillation (AF) related and not related to coronary artery bypass grafting (CABG);
described the use of antithrombotic therapy; and evaluated the association of AF with
mortality.
Methods
We studied 9242 high-risk non-ST-segment elevation (NSTE) ACS patients enrolled in
EARLY ACS. Logistic regression with a landmark approach examined the association between
AF within 7 days post-ACS and 30-day death. Cox proportional hazards modeling assessed the association
of AF with 1-year mortality.
Results
Overall, 551 patients (6.0%) had AF at a median of 4 (25th, 75th percentiles: 2, 8)
days post-ACS. CABG-related AF occurred in 2.6% (N = 242) of the overall population, representing 44% of all AF episodes. At discharge,
patients with AF received aspirin (87%), clopidogrel (48%), or warfarin (19%). Aspirin
plus clopidogrel plus warfarin was used in 5.7% of the overall AF population and in
10.0% of patients with non-CABG-related AF. In-hospital AF within 7 days post-ACS was associated with an adjusted hazard ratio for death between 7 and
30 days of 4.83 (95% confidence interval, 3.06–7.62) as well as higher 1-year mortality
(2.40 [1.90–3.03]).
Conclusions
Overall, AF complicated the in-hospital course of 6% of patients with NSTE ACS and
was associated with substantially greater risk for 30-day and 1-year mortality. Most
patients with AF did not receive oral anticoagulation at discharge, highlighting an
unexplored area of antithrombotic therapy at hospital discharge in these high-risk
patients.
Keywords
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Article info
Publication history
Published online: April 10, 2013
Accepted:
March 13,
2013
Received in revised form:
December 10,
2012
Received:
July 16,
2012
Footnotes
☆Funding: The EARLY ACS trial was funded by Schering-Plough Corporation (now Merck & Co., Inc.). These analyses were funded by research grant support from Merck & Co., Inc., Whitehouse Station, NJ, USA.
☆☆Conflict of interest statement: see Disclosures section at the end of the manuscript.
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
