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)

A. Garvey Rene, Philippe Généreux, Michael Ezekowitz, Ajay J. Kirtane, Ke Xu, Roxana Mehran, Sorin J. Brener, Gregg W. Stone

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)236-242
Number of pages7
JournalAmerican Journal of Cardiology
Volume113
Issue number2
DOIs
StatePublished - Jan 15 2014
Externally publishedYes

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Percutaneous Coronary Intervention
Atrial Fibrillation
Stents
Myocardial Infarction
Confidence Intervals
Hemorrhage
Mortality
ST Elevation Myocardial Infarction
Multivariate Analysis
Stroke
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{32055ed6b26748f181a182a2e6fa646f,
title = "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)",
abstract = "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.",
author = "Rene, {A. Garvey} and Philippe G{\'e}n{\'e}reux and Michael Ezekowitz and Kirtane, {Ajay J.} and Ke Xu and Roxana Mehran and Brener, {Sorin J.} and Stone, {Gregg W.}",
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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). / Rene, A. Garvey; Généreux, Philippe; Ezekowitz, Michael; Kirtane, Ajay J.; Xu, Ke; Mehran, Roxana; Brener, Sorin J.; Stone, Gregg W.

In: American Journal of Cardiology, Vol. 113, No. 2, 15.01.2014, p. 236-242.

Research output: Contribution to journalArticle

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.

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.

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