Abstract 17201: Long Term Clinical Outcomes According to Anticoagulation Therapy in Survivors of Acute Myocardial Infarction Patients Who Develop Atrial Fibrillation: From the Korea Acute Myocardial Infarction Registry
Background: Atrial fibrillation (AF) is common both during hospitalization and after discharge for acute MI and in both time periods has prognostic significance. However, optimal anticoagulation strategy (whether patients with acute MI who develop AF need oral anticoagulation prescribed at discharge and if so for how long) is unknown.
Methods and Results: 582 AMI patients combined with atrial fibrillation were studied from November 2005 to January 2008 from the Korea Acute Myocardial infarction Registry. Hospital mortality was 11.1% (65/582) Survivors of AMI patients (511 patients, 343(67%) male ; mean age, 67.8 ± 11.7 years) were enrolled in this study. These patients were divided into the two groups according to anticoagulation therapy. Triple antithrombotic therapy was prescribed in patients with previous cerebrovascular accident history (p=0.009). There are no statistical difference in age, sex, hypertension, diabetes mellitus, dyslipidemia, smoking, heart failure and CHADS2-VAS score between two groups. 41 patients had MACE during one year follow up period. (27 death, 3 myocardial infarction, 11 re-PCI) Predictors of one year MACE were Age (HR; 1.054, 95% CI= 1.013-1.096, P=0.008), Previous CVA history (HR; 3.668, 95% CI=1.641-8.199, p=0.002), Major bleeding complication during hospitalization (HR; 7.151, 95% CI = 1.097-46.607, p=0.04), Triple antithrombotic therapy (HR: 0.113 , 95% CI = 0.015-0.857, p= 0.035), RAA blockade medication(ACEI or ARB) (HR: 0.387, 95% CI = 0.173-0.862, p=0.02)
Conclusions: In AMI patients who develop AF, oral anticoagulation prescribed at discharge decreased the MACE during one year follow up period. This results supports the fact that oral anticoagulant therapy might be helpful in AMI patients who develop AF during one year. Further large scale prospective studies are needed to determine the optimal combination and duration of anticoagulation therapy.
- © 2013 by American Heart Association, Inc.