Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction.
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.
['Madsen|Jasmine Melissa|JM|', 'Jacobsen|Mia Ravn|MR|', 'Sabbah|Muhammad|M|', 'Topal|Divan Gabriel|DG|', 'Jabbari|Reza|R|', 'Glinge|Charlotte|C|', 'Køber|Lars|L|', 'Torp-Pedersen|Christian|C|', 'Pedersen|Frants|F|', 'Sørensen|Rikke|R|', 'Holmvang|Lene|L|', 'Engstrøm|Thomas|T|', 'Lønborg|Jacob Thomsen|JT|']
D000284:Administration, Oral D000368:Aged D000925:Anticoagulants D001281:Atrial Fibrillation D015331:Cohort Studies D003718:Denmark D005260:Female D006470:Hemorrhage D006801:Humans D015994:Incidence D000083242:Ischemic Stroke D008297:Male D008875:Middle Aged D000076322:Multimorbidity D015999:Multivariate Analysis D062645:Percutaneous Coronary Intervention D011379:Prognosis D012008:Recurrence D012042:Registries D012189:Retrospective Studies D000072657:ST Elevation Myocardial Infarction D013997:Time Factors D016896:Treatment Outcome
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