Atrial Fibrillation Predictors and Outcomes in Patients with Acute Coronary Syndromes

A team of researchers, led by Jean Jacques Noubiap, aimed to evaluate the incidence, risk factors, and prognosis of atrial fibrillation (AFib) in patients with acute coronary syndromes (ACS). Their record, published in the Journal of Cardiovascular Electrophysiology, reported that one in nine patients with ACS develop AFib, with a high proportion of newly diagnosed AFib.

In terms of prognosis, the authors observed that “atrial fibrillation, in particular newly diagnosed atrial fibrillation, is associated with poor short-term and long-term outcomes in patients with ACS.”

The investigators pulled a total of 109 studies from the MEDLINE, Embase, and Web of Science databases and used a random-effects model to calculate pooled estimates.

Across a total of 8,239,364 patients with ACS, the prevalence rates for pre-existing AFib, newly diagnosed AFib, and prevalent (total) Afib were 5.8%, 7.3%, and 11.3%, respectively. The researchers observed that predictors of newly diagnosed cases of AFib included: age (adjusted odds ratio [OR] = 1.05), C-reactive protein (OR = 1.49), left atrial (LA) diameter (OR = 1.08), LA dilation (OR = 2.32), left ventricular ejection fraction <40% (aOR 1.82), hypertension (OR = 1.87), and Killip ˃1 (OR = 1.85) (all p <0.01). In the short term, new diagnoses of AFib were associated with an increased risk of acute heart failure (adjusted hazard ratio (HR = 3.20), acute kidney injury (HR 3.09), re-infarction (HR = 1.96), stroke (HR = 2.15), major bleeding (HR = 2.93), and mortality (HR = 1.80). In the long term (beyond 1 month), they were associated with increased risk of heart failure (HR = 2.21), stroke (HR = 1.75), mortality (HR = 1.67), cardiovascular mortality (HR = 2.09), sudden cardiac death (HR = 1.53), and a combination of major adverse cardiovascular events (HR = 1.54)(p <0.05).

The authors concluded that this pooled analysis of over eight million subjects provided strong support of a possible correlation between ACS and newly diagnosed AFib, with additional evidence that AFib leads to far inferior short- and long-term outcomes for patients.