The risk for acute coronary syndrome associated with atrial fibrillation among ED patients with chest pain syndromes

• Published in: The American journal of emergency medicine Vol. 25; no. 5; pp. 523 - 528
• Main Authors: Brown, Aaron M., BS, Sease, Keara L., MAEd, Robey, Jennifer L., MSN, BSN, Shofer, Frances S., PhD, Hollander, Judd E., MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-06-2007; Elsevier; Elsevier Limited
• Subjects: Acute coronary syndromes; Aged; Analgesics; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angina, Unstable - etiology; Angina, Unstable - physiopathology; Atrial Fibrillation - complications; Atrial Fibrillation - physiopathology; Biological and medical sciences; Cardiac arrhythmia; Cardiology. Vascular system; Cardiovascular disease; Case-Control Studies; Chest Pain - etiology; Chest Pain - physiopathology; Confidence Intervals; Coronary heart disease; Electrocardiography; Emergency; Emergency medical care; Female; Heart; Heart attacks; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - etiology; Myocardial Infarction - physiopathology; Neuropharmacology; Pain; Pharmacology. Drug treatments; Retrospective Studies; Risk Factors; Studies; United States > US; Human; Myocardial infarction; Intensive care; Arrhythmia; Atrial fibrillation; Cardiovascular disease; Coronary heart disease; Myocardial disease; Excitability disorder; Pain; Risk factor; Variant angina; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2006.09.015

Abstract Objective We sought to determine if atrial fibrillation is associated with an increased risk for an acute coronary syndrome (ACS) among emergency department (ED) patients with chest pain syndromes. Methods We performed a retrospective analysis of a prospectively collected database on ED patients with chest pain by selecting patients with atrial fibrillation and frequency-matched control subjects without atrial fibrillation. Measured outcomes were acute myocardial infarction (AMI), ACS, and unstable angina (UA). The relative risks of AMI, ACS, and UA associated with atrial fibrillation were calculated. Results One hundred forty patients with atrial fibrillation and 683 matched control subjects were identified. The rates of AMI for the atrial fibrillation and control groups were 11.4% and 10.8%, respectively; those of ACS were 27.9% and 26.7%, respectively; and those of UA were 16.4% and 15.8%, respectively. The relative risks of AMI and ACS did not increase in patients with atrial fibrillation: AMI, 1.05 (95% confidence interval [CI] = 0.63-1.75); ACS, 1.05 (95% CI = 0.78-1.40); and UA, 1.05 (95% CI = 0.6-1.7). Conclusion Among patients presenting to the ED with chest pain syndromes, atrial fibrillation is not associated with an increased risk for AMI, ACS, and UA.