Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

被引:17
|
作者
Wang, Chun-Li [1 ,2 ]
Chen, Pei-Chun [3 ,4 ]
Juang, Hsiao-Ting [3 ]
Chang, Chee-Jen [1 ,2 ,5 ,6 ]
机构
[1] Chang Gung Mem Hosp, Linkou Med Ctr, Cardiovasc Dept, Internal Med, Taoyuan, Taiwan
[2] Chang Gung Univ, Sch Med, Taoyuan, Taiwan
[3] Chang Gung Univ, Clin Informat & Med Stat Res Ctr, Coll Med, Taoyuan, Taiwan
[4] China Med Univ, Dept Publ Hlth, Taizhong, Taiwan
[5] Chang Gung Univ, Res Serv Ctr Hlth Informat, Taoyuan, Taiwan
[6] Chang Gung Univ, Grad Inst Clin Med, Taoyuan, Taiwan
关键词
Acute coronary syndrome; Atrial fibrillation; Heart failure; Ischemic stroke; Mortality; Systemic embolism; ACUTE MYOCARDIAL-INFARCTION; PROGNOSTIC-SIGNIFICANCE; CLINICAL-FEATURES; HEART-FAILURE; MORTALITY; RISK; PREVALENCE; THERAPY; SEGMENT; TRENDS;
D O I
10.1007/s40119-019-0136-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IntroductionAtrial fibrillation (AF) often occurs in patients with acute coronary syndrome (ACS). It remains unclear whether pre-existing or new-onset AF confers different risk in patients with ACS.MethodsWe conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database. Patients who were hospitalized with a primary diagnosis of ACS from 2005 to 2009 were studied. Major outcomes were mortality, heart failure, and combined ischemic stroke/systemic embolism (IS/SE). The date of the first ACS diagnosis was defined as the index date. Pre-existing AF was defined as AF occurring before the index date. New-onset AF was defined as AF that started after or at the same time as the ACS diagnosis.ResultsAmong 6663 patients with ACS, 488 (7.3%) had pre-existing AF and 479 (7.2%) had new-onset AF. Compared to patients with pre-existing AF, those with new-onset AF were younger, less likely to have co-morbidities, and more likely to receive evidence-based therapy. The un-adjusted risks of adverse outcomes in both groups were similar. Compared to pre-existing AF, new-onset AF was significantly associated with a higher adjusted risk of death (hazard ratio 1.27, 95% confidence interval 1.06-1.52) and IS/SE (hazard ratio 1.49, 95% confidence interval 1.01-2.20). The significant associations between new-onset AF and adverse outcomes were more likely to be observed in elderly patients with ACS.ConclusionsNew-onset AF during ACS was associated with a significantly increased risk of adverse outcomes, especially in the elderly patients.
引用
收藏
页码:117 / 127
页数:11
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