Prognostic significance of new onset atrial fibrillation in acute coronary syndrome patients treated conservatively.
BACKGROUND
The purpose of this study was to assess the association between new onset of atrial fibrillation (AF) and in-hospital management and mortality in acute coronary syndrome patients admitted to hospitals without on-site invasive facilities.


METHODS
We assessed data concerning in-hospital management and mortality of 24 patients with, and 977 patients without, new onset of AF from the Krakow Registry of Acute Coronary Syndromes database.


RESULTS
Patients with new onset of AF were older and more likely to have diabetes, chronic obstructive pulmonary disease, cardiogenic shock and chest pain on admission, and a shorter time from the onset of symptoms to admission. These patients more frequently received glycoprotein IIb/IIIa inhibitors, thrombolytics, and were less likely to be treated with statins during their hospital stay. Risk of AF occurrence was lower in patients treated with statins (1.9% vs 5.2%; p = 0.021). Among patients treated conservatively, in-hospital mortality was higher in patients with new onset of AF (8.1% vs 33.3%; p = 0.001). Independent predictors of inhospital death in this group of patients were: new onset of AF, age, cardiogenic shock, chronic obstructive pulmonary disease, history of renal insufficiency, and discharge diagnosis.


CONCLUSIONS
New onset of AF is associated with excessive in-hospital mortality in acute coronary syndrome patients staying on conservative treatment in community hospitals without on-site invasive facilities.
Dziewierz
Artur
A
2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
Siudak
Zbigniew
Z
Rakowski
Tomasz
T
Jakała
Jacek
J
Dubiel
Jacek S
JS
Dudek
Dariusz
D
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D010343:Patient Admission; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D051437:Renal Insufficiency / Q000150:complications; D012770:Shock, Cardiogenic / Q000150:complications; D013997:Time Factors
D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex