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. 2019 Jan 24;35(2):182-189.
doi: 10.1002/joa3.12154. eCollection 2019 Apr.

New-onset atrial fibrillation in patients with acute coronary syndrome may be associated with worse prognosis and future heart failure

Mizuyoshi Nagai  1 , Tomonori Itoh  1 , Masaru Ishida  1 , Tetsuya Fusazaki  1 , Takashi Komatsu  1 , Motoyuki Nakamura  1 , Yoshihiro Morino  1
Affiliations

New-onset atrial fibrillation in patients with acute coronary syndrome may be associated with worse prognosis and future heart failure

Mizuyoshi Nagai et al. J Arrhythm. .

Abstract

Background: The purpose of this study was to evaluate the prognostic value of atrial fibrillation (AF) in patients with acute coronary syndrome (ACS).

Methods: A total 648 of consecutive ACS patients were divided into non-AF and all-AF groups. The all-AF group was further subdivided into new-onset AF and pre-existing AF groups. We compared prognosis among these groups using the Cox regression analysis.

Results: The mean follow-up period was 1.4 ± 1.2 years. Overall patient numbers were 538 in non-AF and 110 in all-AF groups (67 in new-onset AF and 43 in pre-existing AF). Seventy-eight all-cause deaths and 42 cardiac deaths were observed. New-onset AF had a worse prognosis than the other groups in the Kaplan-Meier analysis (P = 0.025) after observation. Cox regression analysis indicated no significant difference for all-cause death among the three groups. The hazard ratio of congestive heart failure requiring hospitalization was significantly higher in the all-AF and new-onset AF group than in the non-AF group. Multivariate logistic regression analysis revealed that renal dysfunction, peripheral arterial disease, Killip classification ≥2, and left ventricular ejection fraction (LVEF) were independent predictors of all-cause death. The new-onset AF group had the highest prevalence of Killip classification ≥2 and the lowest LVEF.

Conclusion: In our study, AF was not an independent predictor of all-cause death, but new-onset AF may be associated with worse prognosis and future heart failure.

Keywords: CHADS2 score; acute coronary syndrome; atrial fibrillation; mortality; new‐onset atrial fibrillation.

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Conflict of interest statement

The authors have no conflicts of interest directly relevant to the content of this article.

Figures

Figure 1
Figure 1
Distribution of CHADS 2 scores among the new‐onset AF and pre‐existing AF groups. The new‐onset AF group (blue bar) and pre‐existing AF group (orange bar). Distribution of CHADS 2 scores was significantly higher in the pre‐existing AF group than in the new‐onset AF group (P = 0.022)
Figure 2
Figure 2
Kaplan‐Meier analysis of cumulative survival rates for patients with ACS during follow‐up period
See this image and copyright information in PMC

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