An analysis of data from nearly 14,000 patients showed that those with a history of atrial fibrillation (AF) were more likely to experience in-hospital complications and comorbid illnesses following percutaneous coronary intervention (PCI).

“The key finding in this study is that AF is strongly associated with in-hospital adverse outcomes, even after extensive adjustment for other relevant factors,” Nadia R. Sutton, MD, MPH, of the University of Michigan in Ann Arbor and colleagues wrote.

The results come from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium—a prospective, multicenter registry that collects demographic, clinical, procedural, and in-hospital outcomes data from consecutive PCI cases at all nonfederal hospitals in Michigan.


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Patients in the study underwent PCI from April 2011 to December 2014 at 47 hospitals. A total of 113,283 PCIs were performed during the study period. Of those, 13,912 patients (12.3%) had a history of AF. Those patients were compared with a matched cohort.

Incidence of AF varied greatly by institution, from a low of 2.5% to a high of 18.4%.

Dr Sutton and colleagues found that patients with a history of AF were more likely to have postprocedural bleeding, blood transfusion, heart failure, cardiogenic shock, and in-hospital mortality. There were no differences in the incidence of postprocedural stroke, acute kidney injury, dialysis initiation, or vascular complications compared with the matched cohorts.

Researchers also determined after propensity matching that patients with a history of AF were more likely to have postprocedural bleeding, heart failure, cardiogenic shock, and in-hospital mortality (see table).

Complication​​ ​

Odds ratio (95% confidence interval)

Post-procedural bleeding

1.32 (1.15- 1.52)

Heart failure

1.33 (1.17- 1.52)

Cardiogenic shock

1.25 (1.08- 1.48)

In-hospital mortality

1.41 (1.18-1.68)

Patients with a history of AF were also more likely to receive a bare-metal stent or angioplasty alone, and less likely to receive a drug-eluting stent compared with the matched cohort.

Reference

Sutton NR, Seth M, Ruwende C, Gurm HS. Outcomes of patients with atrial fibrillation undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2016;68(9):895=904. doi:10.1016/j.jacc.2016.05.085.