12-month overall mortality in ST-elevation myocardial infarction with newly diagnosed atrial fibrillation and atrial flutter compared between early oral anti-coagulant initiation and delayed oral anti-coagulant initiation
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Abstract
Background: Atrial fibrillation (AF) is a common cardiac arrhythmia after ST elevation myocardial infarction (STEMI) leading to increased short-term and long-term mortality. Recent guidelines recommend starting oral anticoagulant (OAC) based on CHA2DS2-VASc in patients with STEMI and newly diagnosed AF without mentioning a proper time of the OAC initiation.
Objective: To study the effect of early and delayed OAC initiation on 12-month overall mortality rate in patients with STEMI and newly diagnosed AF or atrial flutter.
Methods: We conducted a retrospective cohort study involving hospitalized patients at Siriraj Hospital in Thailand spanning from January 2008 to 2022. Participants with STEMI and newly diagnosed AF or atrial flutter were included. Participants were divided into two groups: the "early OAC group" comprising individuals initiating OAC treatment within index hospitalization, and the "delayed OAC group" including those who did not.
Results: We enrolled a total of 65 participants, with 16 in the early OAC group and 49 in the delayed OAC group. Warfarin is the primary OAC, with only 8.2% of participants in the delayed OAC group receiving warfarin. During the 1-year follow-up period, two deaths (12.5%) occurred in the early OAC group compared to sixteen deaths (32.7%) in the delayed OAC group. The hazard ratio for overall mortality was 0.35 (95% confidence interval [CI], 0.80-1.51; p-value = 0.16). There were 4 nonfatal strokes, all of which occurred before OAC initiation.
Conclusion: Due to limited sample size, we were unable to demonstrate a difference in 12-month overall mortality between early and delayed OAC initiation in patients with STEMI and newly diagnosed AF or atrial flutter. Therefore, the timing of OAC initiation in these patients remains at the discretion of the attending physician.
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