title: Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes.
abstract: BACKGROUND
  We assessed the incidence and timing of post-acute coronary syndrome (ACS) atrial fibrillation (AF) related and not related to coronary artery bypass grafting (CABG); described the use of antithrombotic therapy; and evaluated the association of AF with mortality.
  
  
  METHODS
  We studied 9242 high-risk non-ST-segment elevation (NSTE) ACS patients enrolled in EARLY ACS. Logistic regression with a landmark approach examined the association between AF within 7 days post-ACS and 30-day death. Cox proportional hazards modeling assessed the association of AF with 1-year mortality.
  
  
  RESULTS
  Overall, 551 patients (6.0%) had AF at a median of 4 (25th, 75th percentiles: 2, 8) days post-ACS. CABG-related AF occurred in 2.6% (N=242) of the overall population, representing 44% of all AF episodes. At discharge, patients with AF received aspirin (87%), clopidogrel (48%), or warfarin (19%). Aspirin plus clopidogrel plus warfarin was used in 5.7% of the overall AF population and in 10.0% of patients with non-CABG-related AF. In-hospital AF within 7 days post-ACS was associated with an adjusted hazard ratio for death between 7 and 30 days of 4.83 (95% confidence interval, 3.06-7.62) as well as higher 1-year mortality (2.40 [1.90-3.03]).
  
  
  CONCLUSIONS
  Overall, AF complicated the in-hospital course of 6% of patients with NSTE ACS and was associated with substantially greater risk for 30-day and 1-year mortality. Most patients with AF did not receive oral anticoagulation at discharge, highlighting an unexplored area of antithrombotic therapy at hospital discharge in these high-risk patients.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA. Electronic address: renato.lopes@duke.edu.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: White
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.forename: Matyas
authors.initials: M
authors.lastname: Keltai
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Tricoci
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D001026:Coronary Artery Bypass; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Antithrombotic therapy; Atrial fibrillation; Clinical outcomes; Non-ST-segment elevation acute coronary syndromes