Management and Outcome of Acute Coronary Syndrome Patients in Relation to Prior History of Atrial Fibrillation

Abstract Background The prognostic impact of the timing where new-onset Atrial Fibrillation (AF) occurs in Acute Coronary Syndrome (ACS) patients isn't well studied. Objective Evaluate the predictors and prognostic impact of early-onset AF (EAF) and late-onset AF (LAF) in ACS patients. Methods We analysed 17016 patients with ACS enrolled in a national multicenter registry from October 2010 to January 2019. Patients with history of valvular disease, valve replacement, AF present at hospital admission or those who died in the first 48 hours were excluded. EAF was defined as AF in the first 48 hours of hospitalization and LAF after 48 hours. The primary endpoint was a composite of death and readmission from cardiovascular causes at 1 year. Results The mean age was 65±13 years; 74% were males and 42% had STEMI). 324 (1.9%) had EAF and 344 (2.0%) had LAF. The predictors of EAF were age ≥75 years (OR 2.04, 95% CI 1.53–2.70, p<0.001); history of heart failure (OR 1.82, 95% CI 1.09–3.02, p=0.022), STEMI diagnosis (OR 2.74, 95% CI 2.06–3.61, p<0.001), admission Killip class (KK)≥2 (OR 2.70, 95% CI 1.98–3.69, p<0.001). The predictors of LAF were age ≥75 years (OR 3.15, 95% CI 2.36–4.19, p<0.001), history of stable angina (OR 1.42, 95% CI 1.06–1.90, p=0.018), cerebrovascular disease (OR 1.68, 95% CI 1.14–2.46, p=0.008), COPD (OR 2.33, 95% CI 1.58–3.44, p<0.001), STEMI diagnosis (OR 2.31, 95% CI 1.77–3.03, p<0.001), admission KK ≥2 (OR 2.06, 95% CI 1.54–2.76, p<0.001) and stress hyperglycemia (OR 1.54, 95% CI 1.15–2.05, p=0.003) In STEMI patients only those with LAF had higher symptoms time (245 (IQR 165–400) minutes vs 284 (IQR 200–425) min; p=0.02). During hospitalization, LAF patients had a worse prognosis with a higher rate of heart failure, re-infarction, stroke, major bleeding and death (Table 1). In the follow-up, in multivarite analysis, only LAF was a predictor of the primary endpoint (EAF: HR 0.79, 95% CI 0.50–1.25, p=0.314; LAF: HR 1.45, 95% CI 1.05–2.00, p<0.025). Complications during hospitalization No AF EAF LAF p Death 1.3 6.5 12.5 <0.001 Heart Failure 11.4 38.3 50.3 <0.001 Re-enfarction 1.0 0.9 3.5 <0.001 Stroke 0.5 0.9 3.8 <0.001 Major bleeding 1.3 4.3 4.1 <0.001 Kaplan Meier curve Conclusion Patients with EAF and LAF have different characteristics and outcomes with LAF patients having a worse in-hospital and long term prognosis.

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PS199 The Features of Treatment of Patients With Acute Coronary Syndrome and History of Atrial Fibrillation in Russian Hospitals: Data From Registry Record-3

Global Heart ◽

10.1016/j.gheart.2016.03.162 ◽

2016 ◽

Vol 11 (2) ◽

pp. e46 ◽

Cited By ~ 1

Author(s):

A. Erlikh ◽

N. Gratsiansky

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Coronary Syndrome ◽

History Of ◽

Registry Record

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P672Ischemic and bleeding risk after an acute coronary syndrome in patients with prior history of cancer treated with dual antiplatelet therapy

European Heart Journal ◽

10.1093/eurheartj/ehz747.0278 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

I Munoz Pousa ◽

S Raposeiras Roubin ◽

E Abu-Assi ◽

S Manzano Fernandez ◽

F D'Ascenzo ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Bleeding Risk ◽

Prior History ◽

Patients With Cancer ◽

Coronary Syndrome ◽

History Of ◽

History Of Cancer

Abstract Introduction Very few patients with history of cancer are included in clinical trials. With this study from real-life patients, we try to analyze the ischemic and bleeding risk of patients with history of cancer who were treated with dual antiplatelet therapy (DAPT) after an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without previous history of recent cancer. The impact of prior cancer in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. All events occurred with DAPT, as follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,661 have prior history of cancer (6.4%). Patients with cancer were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with cancer in comparison with the rest of the population (14.5% vs 22.4%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. The unadjusted cumulative incidences of AMI and MB were higher in patients with prior cancer (5.1 and 5.2 per 100 patients/year, respectively) than in those with prior cancer (2.4 and 2.6 per 100 patients/year, respectively). After propensity-score matching, we obtained two matched groups of 1,656 patients. Patients with prior cancer showed a significant higher risk of AMI (sHR 1.44, 95% CI 1.01–2.04, p=0.044), but not higher risk of MB (sHR 1.21, 95% CI 0.88–1.68, p=0.248), in comparison with those without prior cancer. Conclusions In ACS patients discharged with DAPT after PCI, prior history of cancer is an independent factor of higher ischemic risk – in terms of AMI, but it is not an independent predictor of increased hemorrhagic risk.

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e0453 Effect of blood pressure levels on prognosis in patients of non st segment elevated acute coronary syndrome without prior history of hypertension

Heart ◽

10.1136/hrt.2010.208967.453 ◽

2010 ◽

Vol 96 (Suppl 3) ◽

pp. A141-A141

Author(s):

L. Qiang ◽

L. Xiaohui ◽

K. Junping ◽

H. Rong ◽

W. Jiahui ◽

...

Keyword(s):

Blood Pressure ◽

Acute Coronary Syndrome ◽

Prior History ◽

Coronary Syndrome ◽

St Segment ◽

History Of

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Acute Coronary Syndrome (ACS) due to Coronary Artery Embolism in a Patient with Atrial Fibrillation

Case Reports in Cardiology ◽

10.1155/2019/9347198 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Hussein Daoud ◽

Ashraf Abugroun ◽

Shruti Erramilli ◽

Surender Kumar

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Treatment Modalities ◽

Circumflex Artery ◽

Coronary Syndrome ◽

Artery Embolism ◽

Intracoronary Thrombolysis ◽

Coronary Artery Embolism ◽

History Of ◽

Unusual Occurrence

Acute coronary syndrome (ACS) secondary to a coronary embolism is an unusual occurrence, yet an important consideration given the difficult diagnosis. We report a case of a 69-year-old male with a medical history of paroxysmal atrial fibrillation who presented with chest pain and shortness of breath. A coronary angiogram was significant for three focal transluminal and translucent areas in the ostial, mid, and distal circumflex artery consistent with embolic disease. The patient was subsequently managed medically with anticoagulation. Despite being a relatively rare entity, thromboembolism into the coronary arteries can provoke an acute myocardial infarction, with atrial fibrillation being the most common risk factor. Treatment modalities for ACS secondary to thromboembolism include stent placement, intracoronary thrombolysis, and thrombus aspiration.

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Prevalence of First Diagnosed Atrial Fibrillation in Patients Admitted with Acute Coronary Syndrome and with Impaired Renal Function with and without Diabetes Mellitus

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i28b31544 ◽

2021 ◽

pp. 123-128

Author(s):

Nandlal Rathi ◽

Muhammad Zaman Balouch ◽

Shazia Kazi ◽

Salman Ahmed ◽

Abdul Mueed ◽

...

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Renal Function ◽

Risk Factor ◽

Impaired Renal Function ◽

P Value ◽

Coronary Syndrome ◽

History Of ◽

Sugar Levels

Objective: To determine the prevalence of first diagnosed atrial fibrillation in patients admitted with acute coronary syndrome and with impaired renal function with and without diabetes mellitus. Methodology: A total of 434 patients were selected from two different hospitals, 361 from NICVD, Tando Muhammad Khan and 73 from Isra University Hospital, Hyderabad. Both males and females, aged between 18 years to 70 years, first ever presented & admitted with acute coronary syndrome (ACS) and renal impairment were included and whereas, patients with atrial fibrillation (AF) other than first diagnosed, previous history of myocardial infarction/coronary artery bypass grafting (CABG), known case of chronic kidney disease/on dialysis, history of cerebrovascular accident (CVA), patient with valvular heart disease, and pregnant women were excluded from this study. Baseline and clinical data was collected to determine the association with the prevalence of first diagnosed AF through chi-square test and a p value of <0.05 was considered as statistically significant. Results: The mean age ± SD was 49.32±12.47 years. Among them majority were males 66.35% and rural residents 51.15% respectively. The most common risk factor observed in our study was presence of hypertension (N = 231, 53.22%) and among all ACS patients, most common type of ACS was unstable angina (N = 195, 44.93%). The overall prevalence of first diagnosed atrial fibrillation was 12.44% (N = 54) and the overall prevalence of diabetes mellitus was 39.63% (N = 172). Mean random blood sugar levels in diabetic patients was 203.32±105.60 mg/dL, hypertensive patients with DM (48.14%), and patients with STEMI with DM (12.96%) were significantly associated with increased prevalence of first diagnosed atrial fibrillation, p value <0.05. Conclusion: Prevalence of first diagnosed AF is comparatively higher in our study because of the underlying renal impairment. Modifiable risk factor like uncontrolled blood sugar levels has significance association with first diagnosed AF.

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Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618798226 ◽

2018 ◽

Vol 8 (3) ◽

pp. 252-263 ◽

Cited By ~ 8

Author(s):

Lourdes Vicent ◽

Albert Ariza-Solé ◽

Oriol Alegre ◽

Juan Sanchís ◽

Ramón López-Palop ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Poor Prognosis ◽

Prior History ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Female Sex ◽

St Segment ◽

History Of ◽

Elevation Acute Coronary Syndrome ◽

Artery Disease

Background: A worse prognosis has been reported among women with acute coronary syndrome compared to men. Our aim was to address the role of frailty and sex in the management and prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome. Methods: A prospective registry in 44 Spanish hospitals including patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome. Frailty assessment was performed using the FRAIL scale. Results: Of a total of 535 patients, 207 (38.7%) were women. Mean age was 84.8±4.0 years, similar in men and women. A prior history of coronary artery disease was more common in men (146, 44.9%) than in women (46, 22.2%), P<0.001. Frailty was less frequent in men (65, 20.2%) than in women (77, 37.8%), P<0.001. Female sex was an independent predictor of death/hospitalisation (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1–2.4) and of hospitalisation at 6 months (HR 1.6, 95% CI 1.04–2.4). In men, compared to non-frail patients, both a prefrail status (HR 3.47, 95% CI 1.22–9.89) and frailty (HR 3.19, 95% CI 1.08–9.43) were independently associated with higher mortality. In women only frailty was independently associated with higher mortality (HR 5.68, 95% CI 1.91–16.18, compared to prefrailty or robustness). Frailty was associated with readmissions in men (HR 3.34, 95% CI 1.79–6.22) but not in women. Conclusions: In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.

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