Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction
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Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction. / Madsen, Jasmine Melissa; Jacobsen, Mia Ravn; Sabbah, Muhammad; Topal, Divan Gabriel; Jabbari, Reza; Glinge, Charlotte; Køber, Lars; Torp-Pedersen, Christian; Pedersen, Frants; Sørensen, Rikke; Holmvang, Lene; Engstrøm, Thomas; Lønborg, Jacob Thomsen.
I: American Heart Journal, Bind 238, 2021, s. 89-99.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction
AU - Madsen, Jasmine Melissa
AU - Jacobsen, Mia Ravn
AU - Sabbah, Muhammad
AU - Topal, Divan Gabriel
AU - Jabbari, Reza
AU - Glinge, Charlotte
AU - Køber, Lars
AU - Torp-Pedersen, Christian
AU - Pedersen, Frants
AU - Sørensen, Rikke
AU - Holmvang, Lene
AU - Engstrøm, Thomas
AU - Lønborg, Jacob Thomsen
N1 - Copyright © 2021 Elsevier Inc. All rights reserved.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted.METHODS: A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes.RESULTS: Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049).CONCLUSIONS: NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.
AB - BACKGROUND: New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted.METHODS: A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes.RESULTS: Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049).CONCLUSIONS: NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.
KW - Administration, Oral
KW - Aged
KW - Anticoagulants/administration & dosage
KW - Atrial Fibrillation/diagnosis
KW - Cohort Studies
KW - Denmark/epidemiology
KW - Female
KW - Hemorrhage/chemically induced
KW - Humans
KW - Incidence
KW - Ischemic Stroke/epidemiology
KW - Male
KW - Middle Aged
KW - Multimorbidity
KW - Multivariate Analysis
KW - Percutaneous Coronary Intervention
KW - Prognosis
KW - Recurrence
KW - Registries
KW - Retrospective Studies
KW - ST Elevation Myocardial Infarction/complications
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.ahj.2021.04.012
DO - 10.1016/j.ahj.2021.04.012
M3 - Journal article
C2 - 33957102
VL - 238
SP - 89
EP - 99
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -
ID: 288917229