Effect of Concomitant Atrial Fibrillation on In-Hospital Outcomes of Non-ST-Elevation-Acute Coronary Syndrome Related Hospitalizations in the United States.

Abstract Atrial fibrillation (AF) is the most common arrhythmia in patients presenting with acute coronary syndrome (ACS). The present study examined the rates and trends of clinical outcomes and management strategies of non-ST-elevation ACS (NSTE-ACS) related hospitalizations in the United States, in patients with concomitant AF compared to those in sinus rhythm (SR). We analyzed the ‘Nationwide Inpatient Sample’ database (2004-2014) for patients with a primary discharge diagnosis of NSTE-ACS, and further stratified the cohort on the basis of diagnoses into SR and AF groups. Multivariate analysis was performed to examine the association between AF and major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and its components. Out of 4,668,737 NSTE-ACS hospitalizations, the proportions of SR and AF groups were 82.4% (3,848,202) and 17.6% (820,535), respectively. The incidence of AF increased significantly over time from 16.5% (2004) to 19.3% (2014). The AF group was at a greater risk of adverse outcomes with higher rates and adjusted relative risk (RR) of MACCE (12.9% vs. 5.3%; RR:1.74 [1.72,1.75]), mortality (6.5% vs. 3.3%; RR:1.12 [1.11,1.13]), stroke (2.7% vs. 1.5%; RR:1.32 [1.30,1.34]) and bleeding (14.7% vs. 8.8%; RR:1.42 [1.41,1.43]). Furthermore, the AF group was less likely to receive coronary angiography (47.1% vs. 58%) and percutaneous coronary intervention (18.7% vs. 32.6%) in comparison to SR. (p