TY - JOUR
T1 - Impact of atrial fibrillation in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention (from the HORIZONS-AMI [Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction] trial)
AU - Rene, A. Garvey
AU - Généreux, Philippe
AU - Ezekowitz, Michael
AU - Kirtane, Ajay J.
AU - Xu, Ke
AU - Mehran, Roxana
AU - Brener, Sorin J.
AU - Stone, Gregg W.
N1 - Funding Information:
Dr. Mehran has received institutional research grant support from The Medicines Company (Parsippany, New Jersey), Bristol-Myers Squibb/Sanofi (New York, New York), Eli Lilly & Company (Indianapolis, Indiana), and Daiichi-Sankyo (Tokyo, Japan) and has served as a consultant to Abbott Vascular (Santa Clara, California), AstraZeneca (Wilmington, Delaware), Janssen Pharmaceuticals (Beerse, Belgium), Regado Biosciences (Basking Ridge, New Jersey), The Medicines Company, Bristol-Myers Squibb/Sanofi, and Merck & Company (Whitehouse Station, New Jersey). Dr. Stone has served as a consultant to Boston Scientific Corporation (Natick, Massachusetts).
PY - 2014/1/15
Y1 - 2014/1/15
N2 - Atrial fibrillation (AF) has been associated with worse outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. The aim of this study was to evaluate the incidence and impact of new-onset AF after primary PCI in patients with ST-segment elevation myocardial infarctions from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. HORIZONS-AMI was a large-scale, multicenter, international, randomized trial comparing different antithrombotic regimens and stents during primary PCI in patients with ST-segment elevation myocardial infarctions. Three-year ischemic and bleeding end points were compared between patients with and without new-onset AF after PCI. Of the 3,602 patients included in the HORIZONS-AMI study, 3,281 (91.1%) with sinus rhythm at initial presentation had primary PCI as their primary management strategy. Of these, new-onset AF developed in 147 (4.5%). Compared with patients without AF after PCI, patients with new-onset AF had higher 3-year rates of net adverse clinical events (46.5% vs 25.7%, p <0.0001), mortality (11.9% vs 6.3%, p = 0.01), reinfarction (16.4% vs 7.0%, p <0.0001), stroke (5.8% vs 1.5%, p <0.0001), and major bleeding (20.9% vs 8.2%, p <0.0001). By multivariate analysis, new-onset AF after PCI was a powerful independent predictor of net adverse clinical events (hazard ratio 1.74, 95% confidence interval 1.30 to 2.34, p = 0.0002) and major adverse cardiac events (hazard ratio 1.73, 95% confidence interval 1.27 to 2.36) at 3 years. In conclusion, new-onset AF after PCI for ST-segment elevation myocardial infarction was associated with markedly higher rates of adverse events and mortality.
AB - Atrial fibrillation (AF) has been associated with worse outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. The aim of this study was to evaluate the incidence and impact of new-onset AF after primary PCI in patients with ST-segment elevation myocardial infarctions from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. HORIZONS-AMI was a large-scale, multicenter, international, randomized trial comparing different antithrombotic regimens and stents during primary PCI in patients with ST-segment elevation myocardial infarctions. Three-year ischemic and bleeding end points were compared between patients with and without new-onset AF after PCI. Of the 3,602 patients included in the HORIZONS-AMI study, 3,281 (91.1%) with sinus rhythm at initial presentation had primary PCI as their primary management strategy. Of these, new-onset AF developed in 147 (4.5%). Compared with patients without AF after PCI, patients with new-onset AF had higher 3-year rates of net adverse clinical events (46.5% vs 25.7%, p <0.0001), mortality (11.9% vs 6.3%, p = 0.01), reinfarction (16.4% vs 7.0%, p <0.0001), stroke (5.8% vs 1.5%, p <0.0001), and major bleeding (20.9% vs 8.2%, p <0.0001). By multivariate analysis, new-onset AF after PCI was a powerful independent predictor of net adverse clinical events (hazard ratio 1.74, 95% confidence interval 1.30 to 2.34, p = 0.0002) and major adverse cardiac events (hazard ratio 1.73, 95% confidence interval 1.27 to 2.36) at 3 years. In conclusion, new-onset AF after PCI for ST-segment elevation myocardial infarction was associated with markedly higher rates of adverse events and mortality.
UR - http://www.scopus.com/inward/record.url?scp=84891633773&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2013.09.016
DO - 10.1016/j.amjcard.2013.09.016
M3 - Article
AN - SCOPUS:84891633773
SN - 0002-9149
VL - 113
SP - 236
EP - 242
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -