Outcomes and anticoagulant management for new-onset atrial fibrillation in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: Findings from a national multicenter registry and meta-analysis

Zhou, C; Zhang, M; Zhao, Z; Li, E; Zhao, Y; Wang, H; Luo, W; Zheng, K; Liu, Y; Yin, C; Zhang, X; Gao, H; Hou, X; Zhao, D; Ma, C

doi:10.1016/j.hrthm.2025.02.036

Coronary disease & ACS

Outcomes and anticoagulant management for new-onset atrial fibrillation in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: Findings from a national multicenter registry and meta-analysis

Heart RhythmPublished 25 Mar 2025Retrospective cohort study and meta-analysis

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Authors' conclusion

Our study suggests NOAF following PCI is uncommon but associated with poor in-hospital prognosis.

Study context

Population: ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), CCC-ACS project (China)
Participants: 19,288 patients

Comparison: New-onset atrial fibrillation (NOAF) vs no AF after primary PCI
NOAFn = 253
Outcome: Prevalence and prognosis of NOAF after PCI (in-hospital outcomes)
Follow-up: During hospitalization

Methodological detailsregistry, multicentre, propensity-score matched

Registry
Multicentre
Propensity-score matched

Pooled result

As reported in the abstract

NOAF

1.3%

253

NOAF vs Without AFHazard ratio (95% CI)

All-cause mortality

2.26(1.08–4.71)

HF

4.29(2.81–6.55)

Cardiogenic shock

4.30(2.28–8.13)

In-stent thrombosis

6.04(1.71–21.45)

Further pooled results

Outcome	← Lower odds with NOAF ←→ Higher odds with NOAF →	OR (95% CI)
In-hospital stroke (meta-analysis)NOAF vs Without AF	0.10.31310	3.33 (1.73–6.43)
	0.10.31310Odds ratio (log scale)

In-hospital anticoagulant use in NOAF patients

Associated with lower all-cause mortality but similar major bleeding

NOAF independent risk factors

Age ≥65 years, hypertension, stroke, HF, Killip class IV, right coronary artery as culprit

Safety

Outcome	← Lower risk with NOAF ←→ Higher risk with NOAF →	HR (95% CI)
Major bleeding · during hospitalizationNOAF vs Without AF	0.20.5125	2.86 (1.44–5.66)
	0.20.5125Hazard ratio (log scale)

Original publication

Outcomes and anticoagulant management for new-onset atrial fibrillation in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: Findings from a national multicenter registry and meta-analysis. Heart Rhythm. Published 25 March 2025. doi:10.1016/j.hrthm.2025.02.036

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Summarised from the published abstract; every number is checked against it