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Early and late onset de novo Atrial Fibrillation in Acute Coronary Syndrome
Session:
Painel 7 - Doença Coronária 8
Speaker:
Mariana da Silva Santos
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Mariana Da Silva Santos; Hugo Miranda; Inês Grácio De Almeida; Helder Santos; Catarina Sá; Joana Chan Chin; Samuel Almeida; Catarina Santos De Sousa; Luís Santos; João Tavares; Lurdes Almeida; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction</strong>: Atrial Fibrillation (AF) complicates approximately 10% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of AF.</p> <p><strong>Objective</strong>: To evaluate predictors of early onset (<48h) and late onset (≥48h) <em>de novo</em> atrial fibrillation (AF).</p> <p><strong>Methods</strong>: Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 8/01/2019. Patients were divided in two groups: A – patients that presented early onset <em>de novo</em> AF (EOAF), and B – patients that presented late onset <em>de novo</em> AF (LOAF). Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Logistic regression was performed to assess predictors of <em>de novo</em> AF in ACS. Survival analysis was evaluated through Kaplan Meier curve.</p> <p><strong>Results</strong>: Population - 257272 patients (pts) with ACS. Group A (GA) - 584 pts (2.3%); group B (GB) - 360 pts (1.4%).</p> <p>GA were younger (73±13 vs 77±10, p<0.001) with a higher prevalence of smokers (21.3% vs 12.1%, p<0.001). GB had higher rates of diabetes mellitus (40.1% vs 30.2%, p<0.001), angina (30.8% vs 21.4%, p<0.001), previous ACS (22.5% vs 15.4%, p=0.006), previous revascularization (percutaneous coronary intervention 14% vs 9.5%, p=0.032; coronary artery bypass surgery 8.4% vs 3.9%, p=0.004).</p> <p>GA had more chest pain (76.1% vs 67.3%, p=0.001), more ST-segment elevation myocardial infarction (56.8% vs 46.9%, p=0.003) and were admitted directly to the cath lab more often (21.7% vs 13.4%, p=0.001). Normal QRS at admission was more common in GA (80% vs 70.2%, p<0.001) and complete right branch block (CRBB) was more frequent in GB (13.5% vs 6.7%, p<0.001).</p> <p>GB had lower hemoglobin (Hb) levels at admission (12.9±2 vs 13.4±1.9, p<.001), first medical evaluation >120 minutes after symptoms onset (FME>120m) more often (71.6% vs 57.8%, p<0.001) and more in-hospital diuretics usage (72.8% vs 54.3%, p<0.001). Logistic regression confirmed that FME>120m (OR 1.6, p=0.005, CI 1.15-2.22), Hb≤12g/dL (OR 1.53, p=0.018, CI 1.02-2.18), CRBB (OR 1.72, p=0.043, CI 11.02-2.92) and diuretics usage (OR 2.18, p<0.001, CI 1.57-3.01) were predictors of late onset AF.</p> <p>140 LOAF patients and 236 EOAF patients had 1 year of follow up. Event-free survival was higher in EOAF than LOAF (80,3% vs 5,9%; p=0.002, OR 2.072) (Figure 1).</p> <p><strong>Conclusion</strong>: LOAF patients seem to have a poorer prognosis compared to EOAF.</p>
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