Zhonghua Xin Xue Guan Bing Za Zhi. 2026 Jun 24;54(6):646-653. doi: 10.3760/cma.j.cn112148-20250707-00494.
ABSTRACT
Objective: To investigate the clinical characteristics and antithrombotic treatment strategies in patients with acute ST-segment elevation myocardial infarction (STEMI) who develop new-onset atrial fibrillation during the acute phase and undergo emergency percutaneous coronary intervention (PCI), and to evaluate the association between new-onset atrial fibrillation and prognosis in STEMI patients. Methods: This retrospective cohort study consecutively enrolled 142 STEMI patients with atrial fibrillation who underwent coronary angiography and emergency PCI via the emergency green channel at the Department of Cardiology, General Hospital of Northern Theater Command from March 2016 to March 2022. Patients were divided into two groups based on the presence of new-onset atrial fibrillation: the prior atrial fibrillation group (n=61) and the new-onset atrial fibrillation group (n=81). Clinical baseline data, in-hospital and long-term antithrombotic strategies after discharge, and adverse events during follow-up were recorded and compared between the two groups. Multivariate Cox regression analysis was used to assess the association between new-onset atrial fibrillation and adverse outcomes. Results: The mean age of the 142 STEMI patients was (68.0±11.5) years, with 104 males accounting for 73.2%. New-onset atrial fibrillation accounted for 57.0% (81/142) of the patients. Compared with the prior atrial fibrillation group, patients in the new-onset atrial fibrillation group were younger, had a lower prevalence of diabetes and previous stroke, and had lower CHADS-VASc and HAS-BLED scores. Additionally, a higher proportion of patients in the new-onset atrial fibrillation group presented with Killip class Ⅳ at admission. During hospitalization, the new-onset atrial fibrillation group had a higher proportion of amiodarone use and lower prescription rates of angiotensin-converting enzyme inhibitors or angiotensin Ⅱ receptor blockers. Regarding long-term antithrombotic strategies after discharge, patients in the new-onset atrial fibrillation group more frequently received dual antiplatelet therapy (67 (82.7%) vs. 37 (60.7%)), while those in the prior atrial fibrillation group more often received anticoagulation combined with dual antiplatelet therapy (20 (32.8%) vs. 8 (9.9%), P<0.05). During 12-month follow-up, the incidence of net adverse clinical events was 18.5% (15/81) in the new-onset atrial fibrillation group and 24.6% (15/61) in the prior atrial fibrillation group, with no significant difference between the two groups (P>0.05). Multivariate Cox regression analysis confirmed that new-onset atrial fibrillation was not independently associated with adverse outcomes (HR=0.73, 95%CI: 0.31-1.69, P=0.459). Conclusions: More than half of the STEMI patients with atrial fibrillation undergoing emergency PCI had new-onset atrial fibrillation, characterized by a lower prevalence of diabetes and stroke, as well as a greater likelihood of receiving dual antiplatelet therapy as the long-term post-discharge antithrombotic strategy. However, new-onset atrial fibrillation was not independently associated with adverse outcomes.
PMID:42324104 | DOI:10.3760/cma.j.cn112148-20250707-00494