MANAGEMENT AND OUTCOMES IN ACUTE CORONARY SYNDROME WITH ATRIAL FIBRILLATION IN “NON-INVASIVE” CLINIC

Abstract

Aim. To evaluate the management and outcomes in acute coronary syndrome patients (ACS) comorbid with atrial fibrillation (AF) during in-patient period and in 12 months from ACS onset. Material and methods. Into multicenter prospective registry (CCH № 29 of Moscow), beginning December 2013, during 12 months, all consecutive patients included, with ACS, and AF on baseline ECG. Follow-up was continued during hospitalization and in 12 months from ACS (phone call). Results. Totally, 234 patients included. Mean age 72,0±11,6 y.o., 65+73,5%, females — 68,8%, anamnesis of myocardial infarction (MI) — 35,9%, diabetes — 23,9%, known AF before ACS — 65,0%, non-ST-elevation ACS — 97,9%, Killip >I — 7,3%, ST depression on baseline ECG — 89,9%, high troponin level — 59,0%, GRACE risk of fatal outcome >140 points. — 75,2%, median CHA2 DS2 -Vasc — 5 pts. At discharge from hospital, 44% patients received double antiplatelet treatment (DAT), 38% — aspirin with oral anticoagulant (OAC), 33% — warfarin, 23% — new OAC (NOAC). During hospitalization (median 14 days) 7 patients died (3,0%). In 12 months the outcomes were followed in 210 patients (89,8%). By 12 months from ACS onset, 18,1% patients died, and in 12 months but after discharge — 15,3%. New MI after discharge had 1,5%, stroke — 2,5%, and bleeding — 3,5% patients. The part of fatal outcomes in 12 months did not differ in DAT or aspirin with OAC groups (12,1% vs 12,8%; p=0,88). The “remained” prescription rate (i.e. adherence) in 12 months after ACS was maximum for aspirin, OAC and NOAC (71%, 58%, 63%, resp.) and minimum for DAT and aspirin with OAC (20% and 27%, resp.). The independent predictors of death after discharge from hospital up to 12 months from ACS onset were the baseline hemoglobin 140 pts. (OR 6,88; 95% CI 1,44-32,80; р=0,015) and non-prescription of aspirin in discharge (OR 3,21; 95% CI 1,20-8,61; р=0,02). Conclusion. The results of observational study of ACS and AF patients, admitted to Moscow city “non-invasive” clinic, showed high rate of fatal outcomes in 12 months after ACS (18,1%), low adherence to the prescribed treatment after discharge. Also, in the group studied, there were predictors of fatal outcomes in 12 months after ACS.