Author + information
- Ioanna Kosmidou1,
- A. Pieter Kappetein2,
- Patrick Serruys3,
- Bernard Gersh4,
- David Kandzari5,
- Marie-Claude Morice6,
- Andrzej Bochenek7,
- Erick Schampaert8,
- Pierre Page9,
- Joseph Sabik10,
- Thomas McAndrew11 and
- Gregg Stone12
- 1Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, United States
- 2Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 3Imperial College, London, United Kingdom
- 4Mayo Clinic, Rochester, Minnesota, United States
- 5Piedmont Heart Institute, Atlanta, Georgia, United States
- 6CERC, Massy, France
- 7Ist Department of Cardiovascular Surgery, American Heart of Poland, Bielsko-Biała, Poland
- 8Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- 9Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- 10Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 11Cardiovascular Research Foundation, New York, New York, United States
- 12Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation or flutter (NOAF) following PCI or CABG for left main coronary artery disease (LMCAD).
In the EXCEL trial, 1905 pts with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents vs. CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization.
Among 1,772 enrolled pts without atrial fibrillation or flutter on presentation, NOAF developed at a mean of 2.7 ± 2.3 days after revascularization in 118 pts (6.7%), including 116/889 (13.0%) in the CABG arm and 2/883 (0.2%) in the PCI arm (P<0.0001). Age, history of anemia, recent MI within 7 days and treatment by CABG were independent predictors of NOAF. Pts with NOAF had significantly longer duration of hospitalization (15.0 ± 11.4 vs. 8.3 ± 7.5 days, p<0.0001) and more 30-day TIMI major or minor bleeding (16.1% vs. 5.2%, p<0.0001) compared to those without NOAF. At 3 years, pts with vs. without NOAF had higher unadjusted rates of stroke (6.8% vs. 2.3%, p=0.01), death (10.7% vs. 6.2%, p=0.056), and the composite primary outcome of death, MI or stroke (22.9% vs. 14.1%, p=0.009). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (HR 3.67, 95% CI 1.46-9.24, p=0.005), death (HR 2.98, 95% CI 1.48-6.00, p=0.002), cardiovascular death (HR 3.70, 95% CI 1.60-8.55, p=0.002) and the composite of death, MI or stroke (HR 1.95, 95% CI 1.21-3.13, p=0.006).
In pts with LMCAD undergoing revascularization in the EXCEL trial, NOAF was infrequent following PCI but was not uncommon after CABG. The development of NOAF was strongly associated with subsequent death, stroke and major adverse cardiovascular events, warranting prophylactic strategies to prevent its occurrence.
CORONARY: PCI Outcomes