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Background: Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI). The CHA2DS2VASc and CHADS2risk scores are used to identify patients with AF at risk for stroke and to guide oral anticoagulants (OAC) use, including patients with AMI. However, the epidemiology of AF, further stratified according to patients' risk of stroke, has not been well characterized among those hospitalized for AMI. Methods: We examined trends in the frequency of AF, rates of discharge OAC use, and post-discharge outcomes among 6,627 residents of the Worcester, Massachusetts area who survived hospitalization for AMI at 11 medical centers between 1997 and 2011. Results: A total of 1,050AMI patients had AF (16%) andthe majority (91%)had a CHA2DS2VASc score >2.AF rates were highest among patients in the highest stroke risk group. In comparison to patients without AF, patients with AMI and AF in the highest stroke risk category had higher rates of post-discharge complications, including higher 30-day re-hospitalization [27 % vs. 17 %], 30-day post-discharge death [10 % vs. 5%], and 1-year post-discharge death [46 % vs. 18 %] (p<0.001 for all). Notably, fewer than half of guideline-eligible AF patients received an OAC prescription at discharge. Usage rates for other evidence-based therapies such as statins and beta-blockers, lagged in comparison to AMI patients free from AF. Conclusion: Our findings highlight the need to enhance efforts towards stroke prevention among AMI survivors with AF. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review describes the dynamic relationship between diabetes mellitus (DM) and coronary artery disease (CAD) with respect to different revascularization strategies and how angiographic tools such as the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score can supplement clinical decision-making.Recent Findings: The SYNTAX score characterizes the anatomical extent of CAD in terms of the number of lesions, functional importance, and complexity. Studies not limited to patients with DM suggest that percutaneous coronary intervention (PCI) is a reasonable alternative to coronary artery bypass grafting (CABG) in patients with low-medium SYNTAX scores, while patients with high SYNTAX scores should be revascularized with CABG if operable. Similar findings were also observed for diabetes patients with multivessel disease in retrospective pooled analysis. The SYNTAX II score combines anatomical and clinical risk to improve upon the decision regarding the optimal revascularization strategy. The SYNTAX II score can be applied to patients with DM.Summary: The SYNTAX scores provide guidance to clinicians faced with determining the optimal revascularization strategy in patients with DM and advanced CAD. Using a heart team approach, the information can be considered along with other factors that influence PCI or CABG risk. [ABSTRACT FROM AUTHOR]