Clinical significance of atrial fibrillation status in patients with percutaneous coronary intervention

Abstract Background Patients undergoing percutaneous coronary intervention (PCI) often develop atrial fibrillation (AF). We investigated the clinical effects of AF status on in-hospital mortality and complications in patients with PCI using a recent large-scale nationwide dataset. Methods Using a claims-based dataset from 1022 hospitals in Japan between 2012 and 2016, patients with PCI were identified and classified into three groups according to the AF status: no AF, prevalent AF before admission, and incident AF after admission. In-hospital mortality, complications, and medical costs were compared in crude and propensity-matched cohorts. Results In 659,525 hospitalized patients undergoing PCI, prevalent and incident AFs were observed in 6.0% and 1.3% patients, respectively; the AF rates increased over 5 years. A greater proportion of older patients and patients with comorbidities had both these AF statuses; undergoing PCI for acute coronary syndrome was common in incident AF. Prevalent and incident AF statuses were associated with worse crude outcomes and complications during hospitalization. In propensity-matched cohorts, incident AF was associated with higher in-hospital mortality rate, longer length of stay, higher direct costs, and higher rate of complications, including stroke and acute kidney injury, than prevalent AF. These outcomes, except length in-hospital stay, did not change in each AF status over 5 years. Conclusions Prevalent and incident AFs in patients undergoing PCI were associated with deteriorating crude outcomes and complications; particularly, incident AF was associated with worse adjusted outcomes and complications. Further efforts are necessary to improve the outcomes in an aging society where AF incidence is increasing.