Atrial fibrillation linked to adverse outcomes after PCI
MedWire News: Patients with periprocedural atrial fibrillation (AF) are at an increased risk for adverse outcomes after undergoing percutaneous coronary intervention (PCI), research suggests.
"The findings of this study add strength to the current limited evidence supporting the claim that AF portends a poorer prognosis even in the contemporary PCI era compared to patients without AF," write Stephen Duffy (Alfred Hospital, Melbourne, Australia) and co-authors in the American Journal of Cardiology.
They analyzed 30-day clinical outcomes in 3307 consecutive patients with and without AF (defined as an irregular rhythm with rapid atrial fibrillatory waves that varied in shape, amplitude, and timing present at the start of index PCI). All patients underwent PCI between January 2007 and December 2008 and were enrolled in a multicenter Australian registry.
Periprocedural AF was present in 162 (4.9%) patients. These patients were compared with 3145 patients who were not in AF at the start of PCI.
Patients with AF were significantly older (74.1 vs 63.9 years; p<0.001), had higher baseline serum creatinine (0.13 vs 0.10 mmol/L; p=0.01), and lower left ventricular ejection fraction (49.5 vs 53.4%; p<0.001) than patients who did not have AF.
Significantly more AF patients also had a history of heart failure and cerebrovascular and peripheral arterial disease than patients without AF (p≤0.01 for all comparisons).
In-hospital bleeding was significantly more frequent in patients with AF, at 5.0% versus 2.1% (p=0.015), but use of periprocedural glycoprotein IIb/IIIa inhibitors and antithrombins were not significantly different between the two groups.
AF was associated with a more than fourfold increase in 30-day mortality rate, at 9.9% versus 2.2% (p<0.0001). Readmission rates at 30 days were also significantly higher in patients with than without AF, at 17.8% versus 11.1% (p=0.01).
In addition, fewer patients with AF were receiving dual antiplatelet therapy at 30 days (p=0.01).
"Excess 30-day morbidity and mortality after PCI may be due to the higher incidence of comorbidities, bleeding complications, and suboptimal antiplatelet therapy," note the authors.
"In conclusion, patients with periprocedural AF represent a very high-risk group."
By Piriya Mahendra