Objectives
Approximately 5–10% of patients presenting for percutaneous coronary intervention
(PCI) have concurrent atrial fibrillation (AF). To what extent AF portends adverse
long-term outcomes in these patients remains to be defined.
Methods
We analysed data from the multicentre Melbourne Interventional Group Registry from
2014–2018. Patients were identified as being in AF or sinus rhythm (SR) at the commencement
of PCI. The primary endpoint was long-term mortality, obtained via linkage with the
National Death Index.
Results
13,286 procedures were included, with 800 (6.0%) patients in AF and 12,486 (94.0%)
in SR. Compared to SR, patients with AF were older (72.9±10.9 vs 64.1±12.0 p<0.001)
and more likely to have comorbidities including diabetes mellitus (31.3% vs 25.0%
p<0.001), hypertension (74.4% vs 65.1% p<0.001) and moderate to severe left ventricular
systolic dysfunction (36.6% vs 19.5% p<0.001). Atrial fibrillation was associated
with an increased risk of in-hospital mortality (11.0% vs 2.5% p<0.001) and MACE (composite
of all-cause mortality, myocardial infarction, or target vessel revascularisation)
(11.9% vs 4.2% p<0.001). In-hospital major bleeding was more common in the AF group
(3.1% vs 1.0% p<0.001). On Cox proportional hazards modelling, AF was an independent
predictor of long-term mortality (adjusted HR 1.38 95% CI 1.11–1.72 p<0.004) at a
mean follow-up of 2.3±1.5 years.
Conclusions
Preprocedural AF is common among patients presenting for PCI. Preprocedural AF is
associated with high-rates of comorbid illnesses and portends higher risk of short-
and long-term outcomes including mortality underscoring the need for careful evaluation
of its risks prior to PCI.
Keywords
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Article info
Publication history
Published online: February 03, 2022
Accepted:
December 9,
2021
Received in revised form:
November 16,
2021
Received:
February 27,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.