Outcomes and anticoagulant management for new-onset atrial fibrillation in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: Findings from a national multicenter registry and meta-analysis

Abstract

Background

Little is known about the risk factors and prognosis of new-onset atrial fibrillation (NOAF) in patients with primary percutaneous coronary intervention (PCI).

Objective

The purpose of this study was to assess the prevalence and prognosis of NOAF after PCI and the effects of anticoagulation on clinical outcomes.

Method

Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome) project, ST-elevation myocardial infarction (STEMI) patients undergoing PCI were stratified into 2 groups: with NOAF or without any atrial fibrillation. Multivariable logistic regression was used to identify NOAF predictors, and propensity-score matching estimated associations between NOAF and in-hospital outcomes. A meta-analysis was also performed by pooling our results with literature data.

Results

Of 19,288 STEMI patients undergoing PCI, 1.3% (n = 253) experienced NOAF. Independent risk factors were age ≥65 years, history of hypertension, stroke, heart failure, Killip class IV, and right coronary artery as the culprit artery. NOAF was associated with a higher risk of all-cause mortality (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.08–4.71), heart failure (HR 4.29, 95% CI 2.81–6.55), cardiogenic shock (HR 4.30, 95% CI 2.28–8.13), in-stent thrombosis (HR 6.04, 95% CI 1.71–21.45), and major bleeding (HR 2.86, 95% CI 1.44–5.66) during hospitalization. Meta-analysis found that NOAF had a higher risk of in-hospital stroke (odds ratio 3.33, 95% CI 1.73–6.43). In-hospital use of anticoagulants was associated with lower rates of all-cause mortality but similar rates of major bleeding in NOAF patients.

Conclusion

Our study suggests NOAF following PCI is uncommon but associated with poor in-hospital prognosis. Findings support the use of anticoagulants in these patients during hospitalization.