Impact of Atrial Fibrillation in Patients With ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention (From the HORIZONS-AMI [Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction] Trial)

Study Questions:

What is the incidence and impact of new-onset atrial fibrillation (AF) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI)?

Methods:

This was an analysis of patients in HORIZONS-AMI, a prospective, open-label, multicenter trial in which patients with STEMI were randomized to receive either unfractionated heparin plus glycoprotein IIb/IIIa inhibitor or bivalirudin monotherapy before primary PCI. Patients with and without new-onset AF after PCI were compared at 3 years with respect to net adverse clinical events (NACE) and major adverse cardiovascular events (MACE).

Results:

In the population of 3,281 patients, post-PCI new-onset AF developed in 147 (4.5%) patients. New-onset AF was a strong independent predictor of NACE (hazard ratio [HR], 1.74; 95% confidence interval, 1.30-2.34; p = 0.0002) and MACE (HR, 1.73; 95% CI, 1.27-2.36; p = 0.0005). Age and body mass index were the only identifiable predictors of occurrence of new-onset AF. Compared to those without new-onset AF, patients with new-onset AF were more likely to be discharged on warfarin (11% vs. 3%). There were no data available on long-term compliance with or effectiveness of oral anticoagulation.

Conclusions:

The authors concluded that new-onset AF after primary PCI for STEMI is associated with markedly higher rates of long-term bleeding and ischemic events at 3-year follow-up.

Perspective:

The authors’ analysis draws attention to the markedly worse outcomes of patients who develop new-onset AF following PCI for STEMI. Such data imply an important need to define the optimal antithrombotic strategy for AF complicating acute coronary syndrome.

Clinical Topics: Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Myocardial Infarction, Atrial Fibrillation, Percutaneous Coronary Intervention


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