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Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes

Lopes, R. D. et al.

International journal of cardiology. VOL 168; NUMBER 3, ; 2013, 2510-2517 -- Elsevier Science B.V., Amsterdam. Part 3; (pages 2510-2517) -- 2013

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  • Title:
    Incidence, treatment, and outcomes of atrial fibrillation complicating non-ST-segment elevation acute coronary syndromes
  • Author: Lopes, R. D.;
    White, J. A.;
    Atar, D.;
    Keltai, M.;
    Kleiman, N. S.;
    White, H. D.;
    Widimsky, P.;
    Zeymer, U.;
    Giugliano, R. P.;
    Tricoci, P.
  • Found In: International journal of cardiology. VOL 168; NUMBER 3, ; 2013, 2510-2517
  • Journal Title: International journal of cardiology.
  • Subjects: Medicine; Biotechnology; Pharmaceutical Chemistry; LCC: RC; Dewey: 616.12
  • Publication Details: Elsevier Science B.V., Amsterdam.
  • Language: English
  • Abstract: Background: We assessed the incidence and timing of post-acute coronary syndrome (ACS) atrial fibrillation (AF) related and not related to coronary artery bypass grafting (CABG); described the use of antithrombotic therapy; and evaluated the association of AF with mortality. Methods: We studied 9242 high-risk non-ST-segment elevation (NSTE) ACS patients enrolled in EARLY ACS. Logistic regression with a landmark approach examined the association between AF within 7days post-ACS and 30-day death. Cox proportional hazards modeling assessed the association of AF with 1-year mortality. Results: Overall, 551 patients (6.0%) had AF at a median of 4 (25th, 75th percentiles: 2, 8) days post-ACS. CABG-related AF occurred in 2.6% (N=242) of the overall population, representing 44% of all AF episodes. At discharge, patients with AF received aspirin (87%), clopidogrel (48%), or warfarin (19%). Aspirin plus clopidogrel plus warfarin was used in 5.7% of the overall AF population and in 10.0% of patients with non-CABG-related AF. In-hospital AF within 7days post-ACS was associated with an adjusted hazard ratio for death between 7 and 30days of 4.83 (95% confidence interval, 3.06-7.62) as well as higher 1-year mortality (2.40 [1.90-3.03]). Conclusions: Overall, AF complicated the in-hospital course of 6% of patients with NSTE ACS and was associated with substantially greater risk for 30-day and 1-year mortality. Most patients with AF did not receive oral anticoagulation at discharge, highlighting an unexplored area of antithrombotic therapy at hospital discharge in these high-risk patients.
  • Identifier: Journal ISSN: 0167-5273
  • Publication Date: 2013
  • Physical Description: Electronic
  • Shelfmark(s): 4542.158000
  • UIN: ETOCRN341227123

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