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Curriculum Vitae:Cardiology residentTitled in Medicine in 2007.5th year resident of Cardiology in Virgen Macarena Hospital from Seville, Spain. Doctorate in Mecidine in process.Acute cardiac care Master in process
Prognostic impact of atrial fibrillation in acute coronary syndromes: a propensity score matching analysis
By a continuos observation of AMI patients
Methods: We designed a prospective study of patientsfrom 40 centers of Andalucia (Southern Spain), previously included in ARIAM registry (Análisis del Retraso en el Infarto Agudo de Miocardio) from 2001 to 2011.Non adjusted and Adjusted Cox multivariate models were conducted. Propensity score matching (PSM) analysis was performed to adjust baseline characteristic of AF group (AFg)Results: From 39237 patients analyzed, 2852 patients (6.6 %) presented AF. AFg were older (71 ± 9, 8 vs 63 ± 12; p < 0, 00001), more frequently women (34, 6 vs 25, 6%; p < 0, 00001), more likely had cardiovascular risk factors at baseline, and had an adverse outcome during hospitalization: malignant arrhythmias (8, 9 vs 3, 7%; p < 0, 00001), heart failure (46, 7 vs 19% p>0, 0001), cardiogenic shock (16, 7 vs 2, 8 %; p < 0, 00001) and in-hospital mortality (12, 4 vs 5, 1 %; p < 0, 00001). In non-adjusted Cox model, AF (HR 2, 16; p < 0, 0001), age (HR 1, 82; p < 0, 0001 per decade), diabetes (HR 1, 65; p < 0, 0001), malignant arrhythmias (HR 2, 14; p>0, 0001), cardiogenic shock (HR 22, 38; p < 0, 0001) and heart rate (HR) at admission (HR 1, 18; p = 0, 005, every increase of 10 beat min-1) were predictors of in-hospital mortality. Ejection fraction (EF) (HR 0, 67; p = 0, 006, every units of 5%) and beta-blockers(BB) use (HR 0, 2; p < 0, 00001) were protective variables. In adjusted model, age, HR, malignant arrhythmias, BB use, and cardiogenic shock persisted as independent predictors of mortality. After removing the two variables of greatest prognostic impact (shock and arrythmias), AF remained as an independent factor. In adjusted Cox model of 3816 PSM patients, only AF (HR 1, 32; p = 0, 006), cardiogenic shock (HR 15, 6; p < 0, 00001), and malignant arrhythmias (HR 1, 35; p = 0, 009) remained as independent predictors of in-hospital mortality.Conclusions: AF during ACS is associated with a higherrate of in-hospital complications and is an independentpredictor of mortality. The occurrence of AF in the course of ACS should not be considered an isolated event, but a factor with prognostic implications that may require moreaggressive approach.
Pride and prestige to start my career as a cardiologist
It will be a sign of recognition between my colleagues and it will maintain me update in the last trials and news.
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