Atrial Fibrillation Associated With Higher Mortality in STEMI

WASHINGTON, DC — Atrial fibrillation (AF) is independently associated with a higher risk of all-cause mortality in patients presenting with ST-segment elevation myocardial infarction (STEMI), according to research presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology.

According to the study investigators, AF is reported in 7% to 19% of patients with acute STEMI, but there are limited data on the effect of AF on clinical outcomes.

Patients at least 18 years of age who were admitted with acute STEMI were identified using the National Inpatient Sample database (2003-2013).

AF was documented in 339,987 (12.9%) of the 2,632,447 STEMI hospitalizations. Patients with AF were older (74 vs 63 years;

P <.001) and more likely to be women (42% vs 34%; P <.001) and white (85% vs 78%; P <.001). Other comorbidities, such as hypertension, renal failure, diabetes, and congestive heart failure, were more common in patients with AF (P <.001 for all). Patients with AF were also more likely to undergo surgical revascularization but not percutaneous intervention vs patients without AF.

There was a higher risk of adjusted in-hospital mortality (16.3% vs 7.9%; odds ratio [OR], 1.16; 95% CI, 1.15-1.18; P <.001) and increased risk of bleeding complications after both percutaneous coronary intervention (12.2% vs 5.3%; OR, 1.18; 95% CI, 1.16-1.21; P <.001) and coronary artery bypass graft surgery (40% vs 33.5%; OR, 1.11; 95% CI, 1.08-1.13; P <.001).

Patients with AF also had longer lengths of hospital stay compared with patients without AF (7 days vs 4 days; P <.001).

Reference

Garg L, Agrawal S, Agarwal M, et al. Impact of atrial fibrillation on outcomes in patients hospitalized with ST-segment elevation myocardial infarction. Abstract 1204-323. Presented at: the 66th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.