Adverse long-term clinical outcomes among patients with pre-procedural atrial fibrillation undergoing percutaneous coronary intervention.

Abstract

Background: Approximately 5-10% of patients presenting for percutaneous coronary intervention (PCI) have concurrent atrial fibrillation (AF). To what extent AF portends adverse long-term outcomes in these patients remains to be defined. Methods: We analysed data from the multicentre Melbourne Interventional Group Registry from 2008-2018. Patients were identified as being in AF or sinus rhythm (SR) at the commencement of PCI. The primary endpoint was long-term mortality, obtained via linkage with the National Death Index. Multivariate logistic regression was used to compare predictors of long-term mortality. Results: 26,208 procedures were included, with 1,485 (5.7%) patients in AF and 24723 (94.3%) in SR. Compared to SR, patients with AF were older (73.3±10.4 vs 64.0±12.0, p<0.001), more likely to be female (26.8% vs 23%, p=0.001), have diabetes (31.3% vs 25.0%, p<0.001), and left ventricular systolic dysfunction (38.5% vs 21.3%, p<0.001). AF was associated with an increased risk of in-hospital mortality (9.8% vs 2.1%, p<0.001) and MACE (composite of all-cause mortality, myocardial infarction or target vessel revascularisation) (10.7% vs 3.8%, p<0.001). In-hospital major bleeding was more common in the AF group (3.3% vs 1.0%, p<0.001). AF was an independent predictor of long-term mortality (adjusted HR 1.59, 95% CI 1.42–1.78, p<0.001) and was a stronger correlate than age (HR 1.07, 95% CI 1.06–1.07, p<0.001) and cerebrovascular disease (1.27, 95% CI 1.33–1.43, p<0.001). Conclusions: Patients with preprocedural AF represent a high-risk group of patients. When adjusted for other adverse predictors, preprocedural AF was associated with a 1.6 fold increase risk in long-term mortality.