PMID- 31306621 OWN - NLM STAT- MEDLINE DCOM- 20200316 LR - 20200316 IS - 1555-7162 (Electronic) IS - 0002-9343 (Linking) VI - 132 IP - 12 DP - 2019 Dec TI - Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF. PG - 1431-1440.e7 LID - S0002-9343(19)30543-1 [pii] LID - 10.1016/j.amjmed.2019.06.008 [doi] AB - BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes. METHODS: Adults with newly diagnosed atrial fibrillation and >/=1 investigator-defined stroke risk factor were enrolled in GARFIELD-AF between March 2010 and September 2015. The association between prior acute coronary syndromes and long-term outcomes was determined using a Cox proportional hazards model, adjusting for baseline risk factors, oral anticoagulation (OAC) +/- antiplatelet (AP) therapy, and usual care. RESULTS: Of 39,679 patients, 10.5% had a history of acute coronary syndromes. At 2-year follow-up, patients with prior acute coronary syndromes had higher adjusted risks of stroke/systemic embolism (hazard ratio [HR] 1.39; 95% confidence interval [CI], 1.08-1.78), major bleeding (HR 1.30; 95% CI, 0.95 -1.79), all-cause mortality (HR 1.34; 95% CI, 1.21 -1.49), cardiovascular mortality (HR 1.85; 95% CI, 1.51-2.26), and new acute coronary syndromes (HR 3.42; 95% CI, 2.62-4.45). Comparing antithrombotic therapy in the acute coronary syndromes vs no acute coronary syndromes groups, most patients received OAC +/- AP: 60.8% vs 66.1%, but AP therapy was more likely in the acute coronary syndromes group (68.1% vs 32.9%), either alone (34.9% vs 20.8%) or with OAC (33.2% vs 12.1%). Overall, 17.8% in the acute coronary syndromes group received dual AP therapy with (5.3%) or without OAC (12.5%). Among patients with moderate/high risk for stroke/systemic embolism, fewer in the acute coronary syndromes group received OAC with or without AP therapy (Congestive heart failure, Hypertension, Age 75 years, Diabetes mellitus, prior Stroke, TIA, or thromboembolism, Vascular disease, Age 65-74 years, Sex category [CHA(2)DS(2)-VASc] 2: 52.1% vs 64.6%; CHA(2)DS(2)-VASc >/=3: 62.0% vs 70.7%), and the majority with a Hypertension (uncontrolled systolic blood pressure >160 mm Hg), Abnormal renal or liver function, previous Stroke, Bleeding history or predisposition, Labile international normalized ratios, Elderly, and concomitant Drugs or alcohol excess (HAS-BLED) score >/=3 were on AP therapy (83.8% vs 65.5%). CONCLUSIONS: In GARFIELD-AF, previous acute coronary syndromes are associated with worse 2-year outcomes and a greater likelihood of under-treatment with OAC, while two-thirds of patients receive AP therapy. Major bleeding was more common with previous acute coronary syndromes, even after adjusting for all risk factors. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Verheugt, Freek W A AU - Verheugt FWA AD - Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands. Electronic address: F.W.A.Verheugt@olvg.nl. FAU - Ambrosio, Giuseppe AU - Ambrosio G AD - Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy. FAU - Atar, Dan AU - Atar D AD - Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Norway. FAU - Bassand, Jean-Pierre AU - Bassand JP AD - Department of Cardiology, University of Besancon, Besancon, France; Department of Clinical Research, Thrombosis Research Institute, London, United Kingdom. FAU - Camm, A John AU - Camm AJ AD - Department of Cardiology, St. George's University of London, United Kingdom. FAU - Costabel, Juan Pablo AU - Costabel JP AD - Cardiovascular Emergency Care Section, Instituto Cardiovascular de Buenos Aires, Argentina. FAU - Fitzmaurice, David A AU - Fitzmaurice DA AD - WMS - Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom. FAU - Illingworth, Laura AU - Illingworth L AD - Department of Clinical Research, Thrombosis Research Institute, London, United Kingdom. FAU - Goldhaber, Samuel Z AU - Goldhaber SZ AD - Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America. FAU - Goto, Shinya AU - Goto S AD - Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan. FAU - Haas, Sylvia AU - Haas S AD - Formerly Haemostasis and Thrombosis Research Group, Technical University of Munich, Germany. FAU - Jansky, Petr AU - Jansky P AD - Cardiovascular Center, University Hospital Motol, Prague, Czech Republic. FAU - Kayani, Gloria AU - Kayani G AD - Department of Clinical Research, Thrombosis Research Institute, London, United Kingdom. FAU - Stepinska, Janina AU - Stepinska J AD - Department of Intensive Cardiac Therapy, Institute of Cardiology, Warsaw, Poland. FAU - Turpie, Alexander G G AU - Turpie AGG AD - Department of Medicine, McMaster University, Hamilton, Ontario,Canada. FAU - van Eickels, Martin AU - van Eickels M AD - Bayer AG, Berlin, Germany. FAU - Kakkar, Ajay K AU - Kakkar AK AD - Department of Clinical Research, Thrombosis Research Institute, London, United Kingdom; Department of Surgery, University College London, United Kingdom. CN - GARFIELD-AF Investigators LA - eng SI - ClinicalTrials.gov/NCT01090362 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20190712 PL - United States TA - Am J Med JT - The American journal of medicine JID - 0267200 RN - 0 (Anticoagulants) RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Acute Coronary Syndrome/*complications MH - Aged MH - Anticoagulants/adverse effects/therapeutic use MH - Atrial Fibrillation/*complications/*drug therapy MH - Cardiovascular Diseases/etiology/mortality MH - Cause of Death MH - Female MH - Follow-Up Studies MH - Hemorrhage/chemically induced MH - Humans MH - Male MH - Platelet Aggregation Inhibitors/adverse effects/therapeutic use MH - Prognosis MH - Proportional Hazards Models MH - Risk Factors MH - Stroke/etiology/mortality OTO - NOTNLM OT - Anticoagulation OT - Antiplatelet therapy OT - Bleeding OT - Mortality OT - Stroke EDAT- 2019/07/16 06:00 MHDA- 2020/03/17 06:00 CRDT- 2019/07/16 06:00 PHST- 2019/04/26 00:00 [received] PHST- 2019/06/05 00:00 [revised] PHST- 2019/06/06 00:00 [accepted] PHST- 2019/07/16 06:00 [pubmed] PHST- 2020/03/17 06:00 [medline] PHST- 2019/07/16 06:00 [entrez] AID - S0002-9343(19)30543-1 [pii] AID - 10.1016/j.amjmed.2019.06.008 [doi] PST - ppublish SO - Am J Med. 2019 Dec;132(12):1431-1440.e7. doi: 10.1016/j.amjmed.2019.06.008. Epub 2019 Jul 12.