Prognostic significance of new onset atrial fibrillation in acute coronary syndrome patients treated conservatively.

Abstract

BACKGROUND: The purpose of this study was to assess the association between new onset of atrial fibrillation (AF) and in-hospital management and mortality in acute coronary syndrome patients admitted to hospitals without on-site invasive facilities. METHODS: We assessed data concerning in-hospital management and mortality of 24 patients with, and 977 patients without, new onset of AF from the Krakow Registry of Acute Coronary Syndromes database. RESULTS: Patients with new onset of AF were older and more likely to have diabetes, chronic obstructive pulmonary disease, cardiogenic shock and chest pain on admission, and a shorter time from the onset of symptoms to admission. These patients more frequently received glycoprotein IIb/IIIa inhibitors, thrombolytics, and were less likely to be treated with statins during their hospital stay. Risk of AF occurrence was lower in patients treated with statins (1.9% vs 5.2%; p = 0.021). Among patients treated conservatively, in-hospital mortality was higher in patients with new onset of AF (8.1% vs 33.3%; p = 0.001). Independent predictors of inhospital death in this group of patients were: new onset of AF, age, cardiogenic shock, chronic obstructive pulmonary disease, history of renal insufficiency, and discharge diagnosis. CONCLUSIONS: New onset of AF is associated with excessive in-hospital mortality in acute coronary syndrome patients staying on conservative treatment in community hospitals without on-site invasive facilities.