The current impact of atrial fibrillation on prognosis in patients with acute coronary syndrome

Atrial fibrillation (AF) shares numerous risk factors with acute coronary syndrome (ACS), making it a common comorbidity in these patients. Studies have shown that patients with AF often have a worse prognosis compared to those in sinus rhythm. However, the long-term impact of AF on clinical outcomes in ACS patients remains poorly defined.

To assess the effect of AF on cardiovascular (CV) outcomes during follow-up in patients who have experienced an ACS, comparing those with and without AF.

This observational, retrospective study included 470 patients admitted with ACS who underwent percutaneous coronary intervention (PCI) between January 2020 and December 2021, with a minimum follow-up of 23 months. Demographic characteristics, cardiovascular risk factors, ACS type, and therapeutic regimens were collected. The primary outcome was hospitalization due to cardiovascular causes, unplanned PCI, or cardiovascular death. Independent predictors were identified using multivariate logistic regression.

Of the 470 patients, 65 (13.8%) were diagnosed with AF either at admission or during hospitalization, and 63.1% were male. AF patients were older (74.5 ± 9.2 years), more likely to have concomitant arterial hypertension (89.2% vs 63.5%, p<0.001), and less likely to be active smokers (13.8% vs 40.9%). In terms of antiplatelet therapy, the combination of aspirin and clopidogrel was more commonly used in the AF group (53.8% vs 18.6%, p<0.001), while the use of apixaban was significantly higher in the AF group (52.3% vs 1.0%, p=0.009). AF patients also had a higher hemorrhagic risk (63.1% vs 22.6%, p=0.011). When evaluating the composite outcome, AF patients had a higher incidence (32.3% vs 13.6%, p=0.001). In multivariate analysis, AF remained an independent predictor of adverse outcomes (OR = 2.01, 95% CI 1.05–3.83, p=0.034).