Abstract 1519: Atrial Fibrillation Is Independently Associated With A High Risk of Death in Patients With Acute Coronary Syndromes
Purpose: To assess whether atrial fibrillation (AF) is associated with 1-year mortality among patients with acute coronary syndromes (ACS).
Methods: We analyzed the 1-year mortality of 110,588 ACS patients using a pooled database of clinical trials. Cox proportional hazards modeling was used to adjust for baseline characteristics including AF that may be associated with the risk of death within 7 days, and death from day 7 to 1 year. We examined the effect of AF in patients with ST-segment elevation versus those with non ST-segment elevation.
Results: The prevalence of in-hospital AF was 8.0%. Baseline characteristics according to AF or not were: median age (70 vs 62 years), systolic blood pressure (130 vs 130mmHg), Killip class III and IV (4.2% vs 1.6%), history of hypertension (41% vs 48%), diabetes mellitus (19% vs 16%), prior congestive heart failure (7% vs 3.5%), and prior myocardial infarction (23% vs 20%). The figure⇓ shows the significant relationship of AF with mortality in the overall population. AF was significantly associated with an increased risk of in-hospital mortality in the non ST elevation ACS patients (adjusted odds ratio (OR) of 1.9 95% CI 1.5 to 2.5), but not in the ST elevation ACS patients (adjusted OR 1.0 95% CI 0.9 to 1.1). However, AF was significantly associated with an increased risk of death from day 7 to 1 year for both ST and non ST elevation ACS patients (adjusted OR 3.8 95% CI 3.5 to 4.1, and 2.2 95% CI 1.7 to 2.7, respectively).
Conclusion: Among patients with ACS, AF is independently associated with a higher risk of 1-year mortality for both ST and non ST elevation ACS patients. Understanding the reasons for this increased risk may provide opportunity for improving care.