Outcomes at 1 year in atrial fibrillation patients with versus without an acute coronary syndrome: insights from the prospective GARFIELD Registry

Purpose: To compare cardiovascular outcomes in patients with atrial fibrillation (AF) with versus without a history of acute coronary syndrome (ACS). Methods: Adults (≥18 years) with newly diagnosed non-valvular AF and ≥1 additional stroke risk factor (investigator defined) were enrolled at 540 sites in 19 countries. The effect of prior ACS on 1-year outcomes was determined using a Cox proportional hazards model, adjusting for antithrombotic treatment and CHA2DS2-VASc risk factors. Follow-up data were available in 95%. Results: Of the 10,614 adults enrolled, 10% had a history of ACS (Table). Patients with prior ACS were at higher risk of an ACS recurrence versus those without ACS (event rates: 2.8% vs 0.5%; adjusted HR 4.26, 95% CI 1.63-11.10) but not for death (3.8% vs 2.0%; HR 1.01, 95% CI 0.62-1.64), stroke (1.4% vs 1.2%; HR 1.03, 95% CI 0.47-2.25) or major bleed (0.7% vs 0.5%; HR 0.75, 95% CI 0.26-2.18). View this table: Baseline characteristics Conclusions: In AF, a history of ACS is associated with a high 1-year risk of recurrent ACS, but not with more death, stroke or bleeding events.