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Atrial fibrillation (AF) is common in patients presenting with myocardial infarction (MI). Percutaneous coronary intervention (PCI) has been shown to improve cardiovascular outcomes in MI. However, outcomes of PCI in AF patients presenting with MI remain largely unknown.
We analyzed the Nationwide Inpatient Sample (NIS) database to calculate the age-adjusted mortality rate for PCI in AF patients presenting with MI between 2002 and 2011, in adults over 40 years of age. This was then compared to the mortality rate for PCI in non-AF patients with MI. Specific ICD-9-CM codes were used to identify patients and outcomes.
Of 3,226,405 PCIs done during the study period, 472,609 (14.6%) PCIs were done on AF patients, of which 137,870 PCIs were for MI. About 60% of these patients were male. Patients with AF were older (71.3±10.6 years). Overall, the number of PCIs showed a declining trend from 2002 to 2011, but for MI patients, the number of PCIs appeared stable over the years. The age-adjusted in-hospital mortality following PCI in MI was significantly higher in AF group compared to the non-AF group (190.24±17.21 vs. 109.08±5.89 per 100,000; p<0.01). These results are summarized in Figure 1. This trend was seen during the entire study period. The age-adjusted in-hospital mortality following PCI for stable coronary artery disease (CAD) was also significantly higher in AF group compared to non-AF group (65.18± 9.82 vs. 29.24±6.67 per 100,000; p<0.01).
AF is prevalent in MI patients undergoing PCI. AF is associated with increased mortality following PCI for acute MI. AF is not a benign arrhythmia in MI patients, and close attention is warranted in these patients to improve mortality.