Atrial fibrillation and acute coronary syndromes in nonagenarians

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is the most common arrhythmia in the elderly. Age increases both thromboembolic risk and bleeding complications. However, these patients are not anticoagulated on many occasions. AF in the context of acute coronary syndrome (ACS) increases the complexity of the management of these patients and they are underrepresented in clinical trials. Purpose The objective of the study was to analyze the impact of AF in nonagenarian patients at 12 months. Other objectives were to evaluate the therapeutic strategy for ACS and AF and to compare clinical events according to AF subtype and treatment at discharge. Methods A retrospective, multicenter and observational study was carried out, in which all nonagenarian patients admitted for ACS and AF (prevalent or incident) between 2005 and 2018 were consecutively included. Patients with type 2 myocardial infarction were excluded. Baseline characteristics were analyzed and mortality at 12 months was analyzed in all patients and according to AF subtype (incident AF was considered when occurred during admission and prevalent AF was considered in patients with previous history of AF) Results 680 patients with a mean age of 92.6 ± 2.4 years were analyzed. Patients with AF more frequently presented chronic kidney disease (CKD) and non-ST-segment elevation acute coronary syndrome (Non-STEMI) and arterial hypertension (HBP) (Table 1). Mortality rate was similar in patients with previous AF and those without history of AF (Figure 1 A). 21.6% (147) of the patients had AF at admission, of which only 47.7% of the patients were previously anticoagulated. Treatment at discharge is shown in Figure 1 B. Mortality at 1 year according to discharge treatment and AF subtype are represented in figures 1C and 1D. Conclusions This is the largest registry of ACS and AF in this population. Patients with prevalent AF had more frequent Non-STEMI and comorbidities, with a similar mortality to AF subgroup at 1 year. Previous AF was no related to higher mortality in this cohort. Half of the patients were not anticoagulated at discharge. OAC was not associated with prognostic benefit in our series.