Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry

Eur Heart J Acute Cardiovasc Care. 2019 Mar;8(2):121-129. doi: 10.1177/2048872618769057. Epub 2018 Apr 3.

Abstract

Background:: Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear.

Methods:: This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF.

Results:: Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AF patients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AF patients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AF patients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AF patients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92).

Conclusions:: Acute coronary syndrome patients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.

Keywords: Acute coronary syndromes; antithrombotic therapy; atrial fibrillation; registry.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Coronary Syndrome / complications*
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / surgery
  • Aged
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / epidemiology
  • Cause of Death / trends
  • Europe / epidemiology
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Incidence
  • Latin America / epidemiology
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention
  • Prognosis
  • Prospective Studies
  • Registries*
  • Risk Factors
  • Survival Rate / trends
  • Thrombolytic Therapy / methods*
  • Thrombosis / epidemiology*
  • Thrombosis / prevention & control
  • Time Factors

Substances

  • Fibrinolytic Agents