Outcomes and anticoagulant management for new-onset atrial fibrillation in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: Findings from a national multicenter registry and meta-analysis

Abstract

Background: Little is known about the risk factors and prognosis of new-onset atrial fibrillation (NOAF) in patients with primary percutaneous coronary intervention (PCI).

Objective: The purpose of this study was to assess the prevalence and prognosis of NOAF after PCI and the effects of anticoagulation on clinical outcomes.

Method: Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project, ST-elevation myocardial infarction (STEMI) patients undergoing PCI were stratified into 2 groups: with NOAF or without any atrial fibrillation. Multivariable logistic regression was used to identify NOAF predictors, and propensity-score matching estimated associations between NOAF and in-hospital outcomes. A meta-analysis was also performed by pooling our results with literature data.

Results: Of 19,288 STEMI patients undergoing PCI, 1.3% (n = 253) experienced NOAF. Independent risk factors were age ≥65 years, history of hypertension, stroke, heart failure, Killip class IV, and right coronary artery as the culprit artery. NOAF was associated with a higher risk of all-cause mortality (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.08-4.71), heart failure (HR 4.29, 95% CI 2.81-6.55), cardiogenic shock (HR 4.30, 95% CI 2.28-8.13), in-stent thrombosis (HR 6.04, 95% CI 1.71-21.45), and major bleeding (HR 2.86, 95% CI 1.44-5.66) during hospitalization. Meta-analysis found that NOAF had a higher risk of in-hospital stroke (odds ratio 3.33, 95% CI 1.73-6.43). In-hospital use of anticoagulants was associated with lower rates of all-cause mortality but similar rates of major bleeding in NOAF patients.

Conclusion: Our study suggests NOAF following PCI is uncommon but associated with poor in-hospital prognosis. Findings support the use of anticoagulants in these patients during hospitalization.

Keywords: Anticoagulation; Meta-Analysis; New-onset atrial fibrillation; Primary percutaneous coronary intervention; Propensity-score matching; ST-segment elevation myocardial infarction.