Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention: results from the APEX-AMI trial
Lopes RD et al. – Atrial fibrillation (AF) prevalence at baseline and at discharge was 4.8% and 2.5%, respectively. The proportion of pts who developed new onset AF was 6.3%. New onset AF was independently associated with 90-day mortality and was a marker of adverse outcomes in pts undergoing primary percutaneous coronary intervention (PCI). Methods- Study of AF incidence and timing of atrial fibrillation and to describe antithrombotic therapy use and evaluate association of AF with 90-day mortality and other secondary clinical outcomes
- Subjects: 5745 ST-segment elevation myocardial infarction pts treated with primary PCI in APEX-AMI
Results- AF during hospitalization for ~11% of pts
- AF prevalence: 4.8% at baseline and 2.5% at discharge
- Proportion of 5466 pts without AF at baseline who developed new onset AF: 6.3%; 9.3 cases of new onset AF/1000 pt days at risk
- New onset AF independently associated with 90-day mortality after accounting for baseline covariates and in-hospital procedures and complications
- New onset AF associated with shock, congestive heart failure, and stroke in models accounting for baseline covariates
- Of AF pts, 55% did not receive oral anticoagulation therapy at discharge
- Of pts with coronary stents, 5.1% discharged on triple therapy
- Pts at highest risk of stroke (CHADS2 score ≥2) least likely to receive oral anticoagulation at discharge (39%)
- Warfarin use in pts with AF at discharge (43.4%) associated with lower rates of 90-day mortality and stroke
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