Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation

Leonardo De Luca, Gianni Casella, Andrea Rubboli, Lucio Gonzini, Donata Lucci, Alessandro Boccanelli, Francesco Chiarella, Antonio Di Chiara, Stefano De Servi, Andrea Di Lenarda, Giuseppe Di Pasquale, Stefano Savonitto

Research output: Contribution to journalArticle

Abstract

Aims To describe the clinical characteristics, contemporary trends of in-hospital management and outcome of patients admitted for an acute coronary syndrome (ACS) with associated atrial fibrillation (AF). Methods We analyzed data from four Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive ACS patients. Results Out of 16,803 ACS patients, 1019 (6.1%) presented with concomitant AF: 668 with non-ST elevation (NSTE)-ACS and 351 with ST-elevation myocardial infarction (STEMI). As compared to no-AF patients, those with AF were older and had significantly more prior cardiac events and comorbidities (all p < 0.005). A progressive increase occurred over time in the rates of coronary angiography and percutaneous coronary intervention, both in NSTE-ACS (p for trend = 0.0002 and 0.0008, respectively) and STEMI patients with AF at admission (both p for trend < 0.0001), with trends similar to those observed in non-AF patients. Among STEMI patients, in-hospital mortality decreased by 50% in those without AF (7.5% in 2001 to 3.3% in 2014, p < 0.0001), with a similar decrease in those with AF (20% vs 10.7%, p = 0.20), even though not statistically significant. At multivariable analysis, AF on admission was not an independent predictor of in-hospital mortality [odds ratio (OR): 0.82; 95% confidence intervals (CI): 0.52–1.30; p = 0.41 for NSTE-ACS, and OR: 1.07; 95% CI: 0.73–1.57; p = 0.74 for STEMI]. Conclusions Over the last 14 years, the in-hospital management of ACS patients with AF has significantly improved as for patients without AF, with comparable effect in terms of outcome.

Original languageEnglish
Pages (from-to)369-375
Number of pages7
JournalInternational Journal of Cardiology
Volume248
DOIs
Publication statusPublished - Dec 1 2017

Fingerprint

Acute Coronary Syndrome
Atrial Fibrillation
Hospital Mortality
Odds Ratio
Confidence Intervals
Percutaneous Coronary Intervention
Coronary Angiography
Registries
Comorbidity
ST Elevation Myocardial Infarction

Keywords

  • Acute coronary syndromes
  • Atrial fibrillation
  • Epidemiology
  • Registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

De Luca, L., Casella, G., Rubboli, A., Gonzini, L., Lucci, D., Boccanelli, A., ... Savonitto, S. (2017). Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation. International Journal of Cardiology, 248, 369-375. https://doi.org/10.1016/j.ijcard.2017.08.019

Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation. / De Luca, Leonardo; Casella, Gianni; Rubboli, Andrea; Gonzini, Lucio; Lucci, Donata; Boccanelli, Alessandro; Chiarella, Francesco; Di Chiara, Antonio; De Servi, Stefano; Di Lenarda, Andrea; Di Pasquale, Giuseppe; Savonitto, Stefano.

In: International Journal of Cardiology, Vol. 248, 01.12.2017, p. 369-375.

Research output: Contribution to journalArticle

De Luca, L, Casella, G, Rubboli, A, Gonzini, L, Lucci, D, Boccanelli, A, Chiarella, F, Di Chiara, A, De Servi, S, Di Lenarda, A, Di Pasquale, G & Savonitto, S 2017, 'Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation', International Journal of Cardiology, vol. 248, pp. 369-375. https://doi.org/10.1016/j.ijcard.2017.08.019
De Luca, Leonardo ; Casella, Gianni ; Rubboli, Andrea ; Gonzini, Lucio ; Lucci, Donata ; Boccanelli, Alessandro ; Chiarella, Francesco ; Di Chiara, Antonio ; De Servi, Stefano ; Di Lenarda, Andrea ; Di Pasquale, Giuseppe ; Savonitto, Stefano. / Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation. In: International Journal of Cardiology. 2017 ; Vol. 248. pp. 369-375.
@article{fe92a520dd6545ba9731b517e895f9b2,
title = "Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation",
abstract = "Aims To describe the clinical characteristics, contemporary trends of in-hospital management and outcome of patients admitted for an acute coronary syndrome (ACS) with associated atrial fibrillation (AF). Methods We analyzed data from four Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive ACS patients. Results Out of 16,803 ACS patients, 1019 (6.1{\%}) presented with concomitant AF: 668 with non-ST elevation (NSTE)-ACS and 351 with ST-elevation myocardial infarction (STEMI). As compared to no-AF patients, those with AF were older and had significantly more prior cardiac events and comorbidities (all p < 0.005). A progressive increase occurred over time in the rates of coronary angiography and percutaneous coronary intervention, both in NSTE-ACS (p for trend = 0.0002 and 0.0008, respectively) and STEMI patients with AF at admission (both p for trend < 0.0001), with trends similar to those observed in non-AF patients. Among STEMI patients, in-hospital mortality decreased by 50{\%} in those without AF (7.5{\%} in 2001 to 3.3{\%} in 2014, p < 0.0001), with a similar decrease in those with AF (20{\%} vs 10.7{\%}, p = 0.20), even though not statistically significant. At multivariable analysis, AF on admission was not an independent predictor of in-hospital mortality [odds ratio (OR): 0.82; 95{\%} confidence intervals (CI): 0.52–1.30; p = 0.41 for NSTE-ACS, and OR: 1.07; 95{\%} CI: 0.73–1.57; p = 0.74 for STEMI]. Conclusions Over the last 14 years, the in-hospital management of ACS patients with AF has significantly improved as for patients without AF, with comparable effect in terms of outcome.",
keywords = "Acute coronary syndromes, Atrial fibrillation, Epidemiology, Registries",
author = "{De Luca}, Leonardo and Gianni Casella and Andrea Rubboli and Lucio Gonzini and Donata Lucci and Alessandro Boccanelli and Francesco Chiarella and {Di Chiara}, Antonio and {De Servi}, Stefano and {Di Lenarda}, Andrea and {Di Pasquale}, Giuseppe and Stefano Savonitto",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.ijcard.2017.08.019",
language = "English",
volume = "248",
pages = "369--375",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation

AU - De Luca, Leonardo

AU - Casella, Gianni

AU - Rubboli, Andrea

AU - Gonzini, Lucio

AU - Lucci, Donata

AU - Boccanelli, Alessandro

AU - Chiarella, Francesco

AU - Di Chiara, Antonio

AU - De Servi, Stefano

AU - Di Lenarda, Andrea

AU - Di Pasquale, Giuseppe

AU - Savonitto, Stefano

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Aims To describe the clinical characteristics, contemporary trends of in-hospital management and outcome of patients admitted for an acute coronary syndrome (ACS) with associated atrial fibrillation (AF). Methods We analyzed data from four Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive ACS patients. Results Out of 16,803 ACS patients, 1019 (6.1%) presented with concomitant AF: 668 with non-ST elevation (NSTE)-ACS and 351 with ST-elevation myocardial infarction (STEMI). As compared to no-AF patients, those with AF were older and had significantly more prior cardiac events and comorbidities (all p < 0.005). A progressive increase occurred over time in the rates of coronary angiography and percutaneous coronary intervention, both in NSTE-ACS (p for trend = 0.0002 and 0.0008, respectively) and STEMI patients with AF at admission (both p for trend < 0.0001), with trends similar to those observed in non-AF patients. Among STEMI patients, in-hospital mortality decreased by 50% in those without AF (7.5% in 2001 to 3.3% in 2014, p < 0.0001), with a similar decrease in those with AF (20% vs 10.7%, p = 0.20), even though not statistically significant. At multivariable analysis, AF on admission was not an independent predictor of in-hospital mortality [odds ratio (OR): 0.82; 95% confidence intervals (CI): 0.52–1.30; p = 0.41 for NSTE-ACS, and OR: 1.07; 95% CI: 0.73–1.57; p = 0.74 for STEMI]. Conclusions Over the last 14 years, the in-hospital management of ACS patients with AF has significantly improved as for patients without AF, with comparable effect in terms of outcome.

AB - Aims To describe the clinical characteristics, contemporary trends of in-hospital management and outcome of patients admitted for an acute coronary syndrome (ACS) with associated atrial fibrillation (AF). Methods We analyzed data from four Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive ACS patients. Results Out of 16,803 ACS patients, 1019 (6.1%) presented with concomitant AF: 668 with non-ST elevation (NSTE)-ACS and 351 with ST-elevation myocardial infarction (STEMI). As compared to no-AF patients, those with AF were older and had significantly more prior cardiac events and comorbidities (all p < 0.005). A progressive increase occurred over time in the rates of coronary angiography and percutaneous coronary intervention, both in NSTE-ACS (p for trend = 0.0002 and 0.0008, respectively) and STEMI patients with AF at admission (both p for trend < 0.0001), with trends similar to those observed in non-AF patients. Among STEMI patients, in-hospital mortality decreased by 50% in those without AF (7.5% in 2001 to 3.3% in 2014, p < 0.0001), with a similar decrease in those with AF (20% vs 10.7%, p = 0.20), even though not statistically significant. At multivariable analysis, AF on admission was not an independent predictor of in-hospital mortality [odds ratio (OR): 0.82; 95% confidence intervals (CI): 0.52–1.30; p = 0.41 for NSTE-ACS, and OR: 1.07; 95% CI: 0.73–1.57; p = 0.74 for STEMI]. Conclusions Over the last 14 years, the in-hospital management of ACS patients with AF has significantly improved as for patients without AF, with comparable effect in terms of outcome.

KW - Acute coronary syndromes

KW - Atrial fibrillation

KW - Epidemiology

KW - Registries

UR - http://www.scopus.com/inward/record.url?scp=85027398638&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027398638&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2017.08.019

DO - 10.1016/j.ijcard.2017.08.019

M3 - Article

AN - SCOPUS:85027398638

VL - 248

SP - 369

EP - 375

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -