Advertisement
Heart, Lung and Circulation

Adverse 30-Day Clinical Outcomes and Long-Term Mortality Among Patients With Preprocedural Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Published:February 03, 2022DOI:https://doi.org/10.1016/j.hlc.2021.12.013

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lopes R.D.
        • Pieper K.S.
        • Horton J.R.
        • Al-Khatib S.M.
        • Newby L.K.
        • Mehta R.H.
        • et al.
        Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation.
        Heart. 2008; 94: 867-873
        • Chan W.
        • Ajani A.E.
        • Clark D.J.
        • Stub D.
        • Andrianopoulos N.
        • Brennan A.L.
        • et al.
        Impact of periprocedural atrial fibrillation on short-term clinical outcomes following percutaneous coronary intervention.
        Am J Cardiol. 2012; 109: 471-477
        • Choi H.-I.
        • Ahn J.-M.
        • Kang S.H.
        • Lee P.H.
        • Kang S.-J.
        • Lee S.-W.
        • et al.
        Prevalence, management, and long-term (6-year) outcomes of atrial fibrillation among patients receiving drug-eluting coronary stents.
        JACC Cardiovasc Interv. 2017; 10: 1075-1085
        • Chen J.
        • Wang L.Y.
        • Deng C.
        • Jiang X.-H.
        • Chen T.-G.
        The safety and efficacy of oral anticoagulants with dual versus single antiplatelet therapy in patients after percutaneous coronary intervention: A meta-analysis.
        Medicine (Baltimore). 2017; 96e8015
        • Mehran R.
        • Lansky A.J.
        • Witzenbichler B.
        • Guagliumi G.
        • Peruga J.Z.
        • Brodie B.R.
        • et al.
        Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial.
        Lancet. 2009; 374: 1149-1159
        • El-Omar M.M.
        • Dangas G.
        • Mehran R.
        • Lansky A.J.
        • Kipshidze N.N.
        • Polena S.
        • et al.
        Usefulness of atrial fibrillation as a marker of outcome after percutaneous coronary intervention.
        Am J Cardiol. 2003; 91: 232-234
        • Sutton N.R.
        • Seth M.
        • Ruwende C.
        • Gurm H.S.
        Outcomes of patients with atrial fibrillation undergoing percutaneous coronary intervention.
        J Am Coll Cardiol. 2016; 68: 895-904
        • Lip G.Y.
        • Keshishian A.
        • Kamble S.
        • Pan X.
        • Mardekian J.
        • Horblyuk R.
        • et al.
        Real-world comparison of major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban, or warfarin. A propensity score matched analysis.
        Thromb Haemost. 2016; 116: 975-986
        • Zhang Y.
        • Zhang L.
        • Zheng H.
        • Chen H.
        Effects of atrial fibrillation on complications and prognosis of patients receiving emergency PCI after acute myocardial infarction.
        Exp Ther Med. 2018; 16: 3574-3578
        • Golwala H.B.
        • Cannon C.P.
        • Steg P.G.
        • Doros G.
        • Qamar A.
        • Ellis S.G.
        • et al.
        Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials.
        Eur Heart J. 2018; 39: 1726-1735a
        • Granger C.B.
        • Alexander J.H.
        • McMurray J.J.V.
        • Lopes R.D.
        • Hylek E.M.
        • Hanna M.
        • et al.
        Apixaban versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2011; 365: 981-992
        • Connolly S.J.
        • Ezekowitz M.D.
        • Yusuf S.
        • Eikelboom J.
        • Oldgren J.
        • Parekh A.
        • et al.
        Dabigatran versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2009; 361: 1139-1151
        • Patel M.R.
        • Mahaffey K.W.
        • Garg J.
        • Pan G.
        • Singer D.E.
        • Hacke W.
        • et al.
        Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
        N Engl J Med. 2011; 365: 883-891
        • Andrianopoulos N.
        • Dinh D.
        • Duffy S.J.
        • Clark D.J.
        • Brennan A.L.
        • Chan W.
        • et al.
        Quality control activities associated with registries in interventional cardiology and surgery.
        Heart Lung Circ. 2011; 20: 180-186
        • Lagerqvist B.
        • James S.K.
        • Stenestrand U.
        • Landbäck J.
        • Nilsson T.
        • Wallentin L.
        • et al.
        Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden.
        N Engl J Med. 2007; 356: 1009-1019
        • Ajani A.E.
        • Szto G.
        • Duffy S.J.
        • Eccleston D.
        • Lefkovits J.
        • Chew D.P.
        • et al.
        The foundation and launch of the Melbourne Interventional Group: a collaborative interventional cardiology project.
        Heart Lung Circ. 2006; 15: 44-47
        • Chan W.
        • Clark D.J.
        • Ajani A.E.
        • Yap C.-H.
        • Andrianopoulos N.
        • Brennan A.L.
        • et al.
        Progress towards a national cardiac procedure database--development of the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and Melbourne Interventional Group (MIG) registries.
        Heart Lung Circ. 2011; 20: 10-18
        • Lip G.Y.
        • Nieuwlaat R.
        • Pisters R.
        • Lane D.A.
        • Crijns H.G.J.M.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey On Atrial Fibrillation.
        Chest. 2010; 137: 263-272
        • Ellis S.G.
        • Vandormael M.G.
        • Cowley M.J.
        • DiSciascio G.
        • Deligonul U.
        • Topol E.J.
        • et al.
        Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group.
        Circulation. 1990; 82: 1193-1202
        • Mehran R.
        • Rao S.V.
        • Bhatt D.L.
        • GIbson C.M.
        • Caixeta A.
        • Eikelboom J.
        • et al.
        Standardized Bleeding Definitions for Cardiovascular Clinical Trials.
        Circulation. 2011; 123: 2736-2747
        • Cutlip D.E.
        • Windecker S.
        • Mehran R.
        • Boam A.
        • Cohen D.J.
        • van Es G.-A.
        • et al.
        Clinical end points in coronary stent trials.
        Circulation. 2007; 115: 2344-2351
        • Matsuda Y.
        • Ishihara T.
        • Iida O.
        • Asai M.
        • Masuda M.
        • Okamoto S.
        • et al.
        Atrial fibrillation predicts long-term outcomes after percutaneous coronary intervention in patients with coronary artery disease.
        J Am Coll Cardiol. 2018; 71: A1027
        • Pilgrim T.
        • Kalesan B.
        • Zanchin T.
        • Pulver C.
        • Jung S.
        • Mattle H.
        • et al.
        Impact of atrial fibrillation on clinical outcomes among patients with coronary artery disease undergoing revascularisation with drug-eluting stents.
        EuroIntervention. 2013; 8: 1061-1071
        • Benjamin E.J.
        • Wolf P.A.
        • D’Agostino R.B.
        • Silbershatz H.
        • Kannel W.B.
        • Levy D.
        Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.
        Circulation. 1998; 98: 946-952
        • Mehra R.
        • Benjamin E.J.
        • Shahar E.
        • Gottlieb D.J.
        • Nawabit R.
        • Kirchner H.L.
        • et al.
        Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study.
        Am J Respir Crit Care Med. 2006; 173: 910-916
        • Chhatriwalla A.K.
        • Amin A.P.
        • Kennedy K.F.
        • House J.A.
        • Cohen D.J.
        • Rao S.V.
        • et al.
        Association between bleeding events and in-hospital mortality after percutaneous coronary intervention.
        JAMA. 2013; 309: 1022-1029
        • Kwok C.S.
        • Rao S.V.
        • Myint P.K.
        • Keavney B.
        • Nolan J.
        • Ludman P.F.
        • et al.
        Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis.
        Open Heart. 2014; 1e000021
        • Murali S.
        • Vogrin S.
        • Noaman S.
        • Dinh D.T.
        • Brennan A.L.
        • Lefkovits J.
        • et al.
        Bleeding severity in percutaneous coronary intervention (PCI) and its impact on short-term clinical outcomes.
        J Clin Med. 2020; 9
        • Stewart S.
        • Hart C.L.
        • Hole D.J.
        • McMurray J.J.V.
        A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study.
        Am J Med. 2002; 113: 359-364
        • Cha Y.M.
        • Redfield M.M.
        • Shen W.K.
        • Gersh B.J.
        Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle.
        Circulation. 2004; 109: 2839-2843