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Introduction: Recent guidelines for antithrombotic strategy in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) were recently published.

Purpose: To evaluate the impact of antithrombotic strategy in real-world AF patients with ACS, in the occurrence of adverse events at one-year follow-up (all-cause mortality, bleeding and thrombotic events).

Methods: Analysis of consecutive patients admitted with ACS included in a single centre registry. We identified patients with AF. Patients were divided into 4 groups according to antithrombotic therapy strategy: group 1 - oral anticoagulation and dual antiplatelet therapy, Group 2 - dual antiplatelet therapy; group 3: oral anticoagulation and single antiplatelet therapy; group 4: single antiplatelet therapy. Baseline patients characteristics of the 4 groups were compared and Kaplan-Meier curves were performed to analysis the occurrence of events over a one-year follow-up.

Results: We analysed 2216 patients with ACS, between 2005 and 2011, of which 140 had AF (mean age 72.7±10.6 years, 60.7% male). The in-hospital mortality was 5.8% (5.4% vs 12.1% in patients with AF, p = 0.002). In AF patients coronary angioplasty was performed in 54% patients, 38.2% with drug-eluting stent and 55.3% with bare-metal stent. The proportion of patients enrolled in groups 1, 2, 3 and 4 was 17%, 56%, 13% and 14%, respectively. Mortality was 28.6%, and there were 7.1% of haemorrhagic complications and 17.1% of thrombotic events, during one-year follow-up. There were no significant differences in baseline patient characteristics or in risk scores (GRACE, CRUSADE, CHADS2 and HAS-BLED). In groups 1 and 2 the presence of ST elevation myocardial infarction and stent implantation were more frequent. In-hospital mortality was significantly higher in group 2 (p = 0.021), with no significant differences regarding mortality, thromboembolic and haemorrhagic complications, over a period of one year. Although there was no statistical difference in outcome of groups over time (log-rank, p = 0.474), group 1 showed a trend toward lower mortality.

Conclusions: Patients with AF have a substantially higher mortality compared to the global populations of ACS. Antithrombotic therapy strategy had no significant influence on the occurrence of adverse events during one-year follow-up. However, a study in a larger population is needed to confirm these results.

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The European Society of Cardiology
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