ESC 2020 Congress: AF associated with long-term mortality in primary PCI patients regardless of LV function

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Andrija Pavlovic

Atrial fibrillation (AF) is associated with long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI), irrespective of left ventricular (LV) function, a study of the prognostic impact of patients undergoing primary PCI with or without LV dysfunction has concluded.

The findings of the study were presented by Andrija Pavlovic (University of Belgrade Faculty of Medicine, Belgrade, Serbia) at the ESC 2020 Congress (Virtual, 29 August–1 September). However, despite its association with long-term mortality in primary PCI patients, Pavlovic said, the short-term prognostic relevance of AF in STEMI is dependent on the presence of LV dysfunction.

AF and impaired LV function have both been separately associated with an increased risk of mortality following primary PCI in patients with ST-elevation myocardial infarction (STEMI), Pavlovic explained in his presentation, noting that the study sought to comparatively evaluate the impact of AF and LV dysfunction on the risk of mortality in primary PCI patients.

The anlaysis includes 8,651 patients admitted for primary PCI during a ten-year period (2009–2019) from a prospectively captured registry of a high volume tertiary centre, where LV dysfunction was defined as ejection fraction (EF) <40%. Adjusted Cox regression models were used to assess 30-day and one-year mortality hazard.

Pavlovic explained that AF was present in 3.2% of patients, whereas 37% had LV dysfunction. Also, crude mortality rates were increased in the presence either of AF or LV dysfunction and were the highest in the group of patients with AF and EF <40% at 30 days (14.9%) as well as at three years (60.3%).

There was a steep rise in mortality rates after three years of follow-up in patients with AF and LV dysfunction, he said. After multivariable adjustment for other significant mortality predictors—including age, previous stroke, myocardial infarction, diabetes, hyperlipidimia, and anaemia—LV dysfunction alone, and in combination with AF was an important predictor of mortality at both 30 days, with 2x and 2.5x higher mortality rates, respectively, and at three years.

However, presence of atrial fibrillation alone in the absence of an impaired LV function, was not independently associated with mortality at 30 days, rather at three years with high mortality risk of almost 2x.

In conclusion, Pavlovic said, AF is associated with long-term mortality in STEM patients undergoing primary PCI, irrespective of the LV function, however, he added, the short-term prognostic relevance of AF in STEMI is dependent on the presence of LV dysfunction.


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