New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis
Introduction: New-onset atrial fibrillation (AF) frequently complicates myocardial infarction, with an incidence of 6–21%. Objective: To assess the predictors and prognosis of new-onset AF during acute coronary syndromes (ACS). Methods: We performed a retrospective observational cohort study includi...
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Format: | Article |
Language: | English |
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Elsevier
2014-05-01
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Series: | Revista Portuguesa de Cardiologia |
Online Access: | http://www.sciencedirect.com/science/article/pii/S0870255114001048 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Carlos Galvão Braga Vítor Ramos Catarina Vieira Juliana Martins Sílvia Ribeiro António Gaspar Alberto Salgado Pedro Azevedo Miguel Álvares Pereira Sónia Magalhães Adelino Correia |
spellingShingle |
Carlos Galvão Braga Vítor Ramos Catarina Vieira Juliana Martins Sílvia Ribeiro António Gaspar Alberto Salgado Pedro Azevedo Miguel Álvares Pereira Sónia Magalhães Adelino Correia New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis Revista Portuguesa de Cardiologia |
author_facet |
Carlos Galvão Braga Vítor Ramos Catarina Vieira Juliana Martins Sílvia Ribeiro António Gaspar Alberto Salgado Pedro Azevedo Miguel Álvares Pereira Sónia Magalhães Adelino Correia |
author_sort |
Carlos Galvão Braga |
title |
New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis |
title_short |
New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis |
title_full |
New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis |
title_fullStr |
New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis |
title_full_unstemmed |
New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis |
title_sort |
new-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis |
publisher |
Elsevier |
series |
Revista Portuguesa de Cardiologia |
issn |
0870-2551 |
publishDate |
2014-05-01 |
description |
Introduction: New-onset atrial fibrillation (AF) frequently complicates myocardial infarction, with an incidence of 6–21%. Objective: To assess the predictors and prognosis of new-onset AF during acute coronary syndromes (ACS). Methods: We performed a retrospective observational cohort study including 902 consecutive patients (mean age 64 years, 77.5% male) admitted to a single center over a two-year period, with a six-month follow-up. Results: AF rhythm was identified in 13.8% patients, of whom 73.3% presented new-onset AF and 26.8% pre-existing AF. New-onset AF was more frequent in older (p<0.001) and hypertensive patients (p=0.001) and in those with previous valvular heart disease (p<0.001) and coronary artery bypass grafting (p=0.049). During hospitalization, patients with new-onset AF more often had respiratory infection (p=0.002) and heart failure (p<0.001), and higher values of NT-proBNP (p=0.007) and peak creatinine (p=0.001). On echocardiography they had greater left atrial (LA) diameter (p<0.001) and more frequent significant mitral regurgitation (p<0.001) and left ventricular ejection fraction (LVEF) ≤40% (p<0.001) and were less likely to have significant coronary lesions (p=0.009) or to have undergone coronary revascularization (p<0.001). In multivariate analysis, age (OR 1.06, p=0.021), LVEF ≤40% (OR 4.91, p=0.002) and LA diameter (OR 1.14, p=0.008) remained independent predictors of new-onset AF. Together with age, diabetes and maximum Killip class, this arrhythmia was an independent predictor of overall mortality (OR 3.11, p=0.032). Conclusions: Age, LVEF ≤40% and LA diameter are independent predictors of new-onset AF during ACS. This arrhythmia is associated with higher overall mortality (in-hospital and in follow-up). Resumo: Introdução: A fibrilhação auricular (FA) de novo complica frequentemente o enfarte agudo do miocárdio, tendo uma incidência entre 6-21%. Objetivos: Determinar os preditores e prognóstico da FA de novo nas síndromes coronárias agudas (SCA). Métodos: Estudo retrospetivo observacional de coorte, incluindo 902 doentes consecutivos (idade média: 64 anos; 77,5% homens), admitidos num hospital, durante dois anos, com follow-up de seis meses. Resultados: O ritmo de FA foi identificado em 13,8% doentes, dos quais 73,3% apresentaram FA de novo e 26,8% FA pré-existente. A FA de novo ocorreu mais nos idosos (p < 0,001), hipertensos (p = 0,001), doentes com história de patologia valvular (p < 0,001) e cirurgia de revascularização miocárdica (p = 0,049). No internamento, verificou-se maior incidência de infeção respiratória (p = 0,002) e insuficiência cardíaca (p < 0,001). Aferiram-se valores superiores de NT-proBNP (p = 0,007) e creatinina pico (p = 0,001). Na avaliação ecocardiográfica observou-se um diâmetro superior da aurícula esquerda (AE; p < 0,001), maior prevalência de insuficiência mitral significativa (grau ≥ II/IV; p < 0,001) e fração de ejeção ventricular esquerda ≤ 40% (FEVE ≤ 40%; p < 0,001). Documentou-se ausência de lesões coronárias significativas (p = 0,009) e não-revascularização coronária (p < 0,001). Na análise multivariada, a idade (OR 1,06, p = 0,021), a FEVE ≤ 40% (OR 4,91, p = 0,002) e o diâmetro da AE (OR 1,14, p = 0,008) permaneceram preditores independentes da FA de novo. Juntamente com a idade, diabetes, e classe de Killip máxima, a FA de novo foi preditora independente da mortalidade global (OR 3,11, p = 0,032). Conclusões: A idade, FEVE≤40% e diâmetro da AE são preditores independentes da FA de novo durante as SCA. Esta arritmia acarreta uma maior mortalidade global (mortalidade intra-hospitalar e durante o seguimento). Keywords: Atrial fibrillation, Acute coronary syndrome, Risk factors, Prognosis, Palavras-chave: Fibrilhação auricular, Síndrome coronária aguda, Fatores de risco, Prognóstico |
url |
http://www.sciencedirect.com/science/article/pii/S0870255114001048 |
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doaj-4eac788b6c7b4351b515da1a06bccbdb2020-11-25T02:11:02ZengElsevierRevista Portuguesa de Cardiologia0870-25512014-05-01335281287New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosisCarlos Galvão Braga0Vítor Ramos1Catarina Vieira2Juliana Martins3Sílvia Ribeiro4António Gaspar5Alberto Salgado6Pedro Azevedo7Miguel Álvares Pereira8Sónia Magalhães9Adelino Correia10Corresponding author.; Serviço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalServiço de Cardiologia, Hospital de Braga, Braga, PortugalIntroduction: New-onset atrial fibrillation (AF) frequently complicates myocardial infarction, with an incidence of 6–21%. Objective: To assess the predictors and prognosis of new-onset AF during acute coronary syndromes (ACS). Methods: We performed a retrospective observational cohort study including 902 consecutive patients (mean age 64 years, 77.5% male) admitted to a single center over a two-year period, with a six-month follow-up. Results: AF rhythm was identified in 13.8% patients, of whom 73.3% presented new-onset AF and 26.8% pre-existing AF. New-onset AF was more frequent in older (p<0.001) and hypertensive patients (p=0.001) and in those with previous valvular heart disease (p<0.001) and coronary artery bypass grafting (p=0.049). During hospitalization, patients with new-onset AF more often had respiratory infection (p=0.002) and heart failure (p<0.001), and higher values of NT-proBNP (p=0.007) and peak creatinine (p=0.001). On echocardiography they had greater left atrial (LA) diameter (p<0.001) and more frequent significant mitral regurgitation (p<0.001) and left ventricular ejection fraction (LVEF) ≤40% (p<0.001) and were less likely to have significant coronary lesions (p=0.009) or to have undergone coronary revascularization (p<0.001). In multivariate analysis, age (OR 1.06, p=0.021), LVEF ≤40% (OR 4.91, p=0.002) and LA diameter (OR 1.14, p=0.008) remained independent predictors of new-onset AF. Together with age, diabetes and maximum Killip class, this arrhythmia was an independent predictor of overall mortality (OR 3.11, p=0.032). Conclusions: Age, LVEF ≤40% and LA diameter are independent predictors of new-onset AF during ACS. This arrhythmia is associated with higher overall mortality (in-hospital and in follow-up). Resumo: Introdução: A fibrilhação auricular (FA) de novo complica frequentemente o enfarte agudo do miocárdio, tendo uma incidência entre 6-21%. Objetivos: Determinar os preditores e prognóstico da FA de novo nas síndromes coronárias agudas (SCA). Métodos: Estudo retrospetivo observacional de coorte, incluindo 902 doentes consecutivos (idade média: 64 anos; 77,5% homens), admitidos num hospital, durante dois anos, com follow-up de seis meses. Resultados: O ritmo de FA foi identificado em 13,8% doentes, dos quais 73,3% apresentaram FA de novo e 26,8% FA pré-existente. A FA de novo ocorreu mais nos idosos (p < 0,001), hipertensos (p = 0,001), doentes com história de patologia valvular (p < 0,001) e cirurgia de revascularização miocárdica (p = 0,049). No internamento, verificou-se maior incidência de infeção respiratória (p = 0,002) e insuficiência cardíaca (p < 0,001). Aferiram-se valores superiores de NT-proBNP (p = 0,007) e creatinina pico (p = 0,001). Na avaliação ecocardiográfica observou-se um diâmetro superior da aurícula esquerda (AE; p < 0,001), maior prevalência de insuficiência mitral significativa (grau ≥ II/IV; p < 0,001) e fração de ejeção ventricular esquerda ≤ 40% (FEVE ≤ 40%; p < 0,001). Documentou-se ausência de lesões coronárias significativas (p = 0,009) e não-revascularização coronária (p < 0,001). Na análise multivariada, a idade (OR 1,06, p = 0,021), a FEVE ≤ 40% (OR 4,91, p = 0,002) e o diâmetro da AE (OR 1,14, p = 0,008) permaneceram preditores independentes da FA de novo. Juntamente com a idade, diabetes, e classe de Killip máxima, a FA de novo foi preditora independente da mortalidade global (OR 3,11, p = 0,032). Conclusões: A idade, FEVE≤40% e diâmetro da AE são preditores independentes da FA de novo durante as SCA. Esta arritmia acarreta uma maior mortalidade global (mortalidade intra-hospitalar e durante o seguimento). Keywords: Atrial fibrillation, Acute coronary syndrome, Risk factors, Prognosis, Palavras-chave: Fibrilhação auricular, Síndrome coronária aguda, Fatores de risco, Prognósticohttp://www.sciencedirect.com/science/article/pii/S0870255114001048 |