Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun;8(1):117-127.
doi: 10.1007/s40119-019-0136-3. Epub 2019 Apr 17.

Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

Chun-Li Wang  1   2 , Pei-Chun Chen  3   4 , Hsiao-Ting Juang  3 , Chee-Jen Chang  5   6   7   8
Affiliations

Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

Chun-Li Wang et al. Cardiol Ther. 2019 Jun.

Abstract

Introduction: Atrial fibrillation (AF) often occurs in patients with acute coronary syndrome (ACS). It remains unclear whether pre-existing or new-onset AF confers different risk in patients with ACS.

Methods: We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database. Patients who were hospitalized with a primary diagnosis of ACS from 2005 to 2009 were studied. Major outcomes were mortality, heart failure, and combined ischemic stroke/systemic embolism (IS/SE). The date of the first ACS diagnosis was defined as the index date. Pre-existing AF was defined as AF occurring before the index date. New-onset AF was defined as AF that started after or at the same time as the ACS diagnosis.

Results: Among 6663 patients with ACS, 488 (7.3%) had pre-existing AF and 479 (7.2%) had new-onset AF. Compared to patients with pre-existing AF, those with new-onset AF were younger, less likely to have co-morbidities, and more likely to receive evidence-based therapy. The un-adjusted risks of adverse outcomes in both groups were similar. Compared to pre-existing AF, new-onset AF was significantly associated with a higher adjusted risk of death (hazard ratio 1.27, 95% confidence interval 1.06-1.52) and IS/SE (hazard ratio 1.49, 95% confidence interval 1.01-2.20). The significant associations between new-onset AF and adverse outcomes were more likely to be observed in elderly patients with ACS.

Conclusions: New-onset AF during ACS was associated with a significantly increased risk of adverse outcomes, especially in the elderly patients.

Keywords: Acute coronary syndrome; Atrial fibrillation; Heart failure; Ischemic stroke; Mortality; Systemic embolism.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart indicating the process of patient selection for the study. Pre-existing AF occurred before the diagnosis of ACS and new-onset AF occurred after or at the same time of ACS diagnosis. ACS acute coronary syndrome, AF atrial fibrillation, NHIRD the National Health Insurance Research Database
Fig. 2
Fig. 2
Adjusted event-free survival curves for a death, b heart failure, c ischemic stroke/systemic embolism. ACS acute coronary syndrome, AF atrial fibrillation
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. McManus DD, Huang W, Domakonda KV, et al. Trends in atrial fibrillation in patients hospitalized with an acute coronary syndrome. Am J Med. 2012;125:1076–1084. doi: 10.1016/j.amjmed.2012.05.024. - DOI - PMC - PubMed
    1. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30:1038–1045. doi: 10.1093/eurheartj/ehn579. - DOI - PubMed
    1. Asanin M, Perunicic J, Mrdovic I, et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. Eur J Heart Fail. 2005;7:671–676. doi: 10.1016/j.ejheart.2004.07.018. - DOI - PubMed
    1. Morishima I, Tomomatsu T, Okumura K, et al. New-onset atrial fibrillation may be a more important predictor of cardiac mortality in acute myocardial infarction patients than preexisting atrial fibrillation. Int J Cardiol. 2015;187:475–477. doi: 10.1016/j.ijcard.2015.03.379. - DOI - PubMed
    1. Poci D, Hartford M, Karlsson T, et al. Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest. 2012;141:1431–1440. doi: 10.1378/chest.11-0435. - DOI - PubMed

LinkOut - more resources