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Atrial Fibrillation and Post-PCI Clinical Outcomes
Study Questions:
What is the association between atrial fibrillation (AF) and in-hospital adverse outcomes after percutaneous coronary intervention (PCI) using a large prospective multicenter registry?
Methods:
Data for consecutive PCI cases from 47 hospitals performed between April 2011 and December 2014 were utilized for the analysis. Propensity-matched multivariate analysis was used to adjust for differences in baseline characteristics between patients with and without a history of AF.
Results:
Of 113,283 PCI cases during the study period, a history of AF was present in 13,912 patients (12%), which varied by institution (range, 2.5-18.4%). At baseline, patients with a history of AF were older and were more likely to have comorbid congestive heart failure, cardiomyopathy, cerebrovascular disease, and chronic lung disease. Patients with a history of AF were more likely to have in-hospital complications, including in-hospital mortality (3% vs. 1%). In propensity-matched analysis, patients with a history of AF were more likely to be treated with a bare-metal stent (27% vs. 18%). In the propensity-matched model, AF remained independently associated with an increased risk of developing post-procedural bleeding (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.15-1.52), heart failure (OR, 1.33; 95% CI, 1.17-1.52), cardiogenic shock (OR, 1.26; 95% CI, 1.08-1.48), and in-hospital mortality (OR, 1.41; 95% CI, 1.18-1.68).
Conclusions:
The authors concluded that AF is common among patients undergoing PCI and independently associated with in-hospital post-procedural heart failure, cardiogenic shock, and mortality.
Perspective:
This study reports that AF is strongly associated with in-hospital adverse outcomes after PCI, even after extensive adjustment for other relevant factors. Those with a history of AF were found to have a higher rate of post-procedural bleeding, need for transfusion, heart failure, cardiogenic shock, and mortality. Overall, these findings indicate that a history of AF is a marker of patients who are vulnerable to serious in-hospital complications after PCI. Additional studies are indicated to better understand the mechanism of the adverse consequences of AF among patients undergoing PCI.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiomyopathies, Heart Failure, Hemorrhage, Hospital Mortality, Lung Diseases, Percutaneous Coronary Intervention, Shock, Cardiogenic, Stents, Treatment Outcome
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