title: Impact of periprocedural atrial fibrillation on short-term clinical outcomes following percutaneous coronary intervention.
abstract: There are few data on the incidence and clinical outcomes of patients with atrial fibrillation (AF) treated in the era of percutaneous coronary intervention (PCI). We analyzed 30-day clinical outcomes in 3,307 consecutive patients with and without AF (sinus rhythm) undergoing PCI from January 2007 through December 2008 enrolled in a multicenter Australian registry. Periprocedural AF was present in 162 patients (4.9%). AF was associated with older age (74.1 ± 8.9 vs 63.9 ± 11.9 years, p <0.001), higher baseline serum creatinine (0.13 ± 0.14 vs 0.10 ± 0.13 mmol/L, p = 0.01), and lower left ventricular ejection fraction (49.5 ± 13.2% vs 53.4% ± 11.6%, p <0.001). Significantly more patients with AF had a history of heart failure and cerebrovascular and peripheral arterial diseases (p ≤0.01 for all comparisons). Periprocedural glycoprotein IIb/IIIa inhibitor (31.5% vs 31.4%, p = 0.98) and antithrombin use were not different between groups, but in-hospital bleeding complications were higher in patients with AF (5.0% vs 2.1%, p = 0.015). Fewer patients with AF received drug-eluting stents (p = 0.004). AF was associated with a greater than fourfold increase in 30-day mortality (9.9% vs 2.2%, p <0.0001) and readmission rates at 30 days (p = 0.01). Fewer patients with AF were on dual antiplatelet therapy at 30 days (86.3% vs 94.3%, p <0.0001), although 28.1% of patients with AF were on triple therapy (dual antiplatelet therapy plus oral anticoagulation). In conclusion, patients with periprocedural AF represent a very high-risk group. Excess 30-day morbidity and mortality after PCI may be due to the higher incidence of co-morbidities, bleeding complications, and suboptimal antiplatelet therapy.
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.forename: Dion
authors.initials: D
authors.lastname: Stub
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.forename: Angela L
authors.initials: AL
authors.lastname: Brennan
authors.forename: Gishel
authors.initials: G
authors.lastname: New
authors.forename: Martin
authors.initials: M
authors.lastname: Sebastian
authors.forename: Rozanne
authors.initials: R
authors.lastname: Johnston
authors.forename: Antony
authors.initials: A
authors.lastname: Walton
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Dart
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality*; D001315:Australia / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D004363:Drug Utilization; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D013318:Stroke Volume
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D003404:Creatinine