Background: Atrial fibrillation (AF) often complicates AMI with an incidence between 6%-21%. AF is associated with a worse prognosis, increased mortality and a high risk for ischemic stroke.
The guidelines concerning the treatment for new onset AF in patient with ACS recommend giving triple therapy for 4 weeks-6 months depending on the CHA2DS2-VASC score and the hemorrhagic risk.
The aim of this study was to characterize ACS patients with new AF and compare their short and long-term outcome with the patients with ACS that did not develop AF. We also evaluated the keeping with medical guidelines in regard to anticoagulation treatment in the AF group
Methods: The clinical characteristics, outcomes and rate of triple therapy in all patients admitted for ACS with new AF were recorded and compared to ACS patients without AF in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) during 2013
Results: 1896 patients were admitted with the diagnosis of ACS. 4% of the patients were complicated with new AF. Older age, prior CABG, CHF, CRD and PVD were significantly more common in the new AF group. Hospital mortality, 30 days mortality, MACE at 30 days and Stroke during hospitalization was significantly higher in the new AF group (p<0.05). 88% of the patients with new AF had a CHA2DS2-VASC of >1. Only 16% of the patients received triple therapy and 7% received dual therapy which included anticoagulation treatment. 35% of patients that did not receive triple therapy had HAS-BLED score< 2.
Conclusion: The short and long-term outcome of patients with new AF complicating ACS was worse compared to patients that without AF including a higher risk for ischemic stroke during hospitalization. A large share of patients with new AF complicated ACS did not receive anticoagulation therapy despite a clear indication in the medical guidelines.
