The association between atrial fibrillation and in-hospital outcomes in chronic kidney disease patients with acute coronary syndrome: findings from the improving care for cardiovascular disease in China-acute coronary syndrome (CCC-ACS) project

Lijiao Yang, Nan Ye, Guoqin Wang, Weijing Bian, Fengbo Xu, Dong Zhao, Jing Liu, Yongchen Hao, Jun Liu, Na Yang, Hong Cheng, CCC-ACS, Lijiao Yang, Nan Ye, Guoqin Wang, Weijing Bian, Fengbo Xu, Dong Zhao, Jing Liu, Yongchen Hao, Jun Liu, Na Yang, Hong Cheng, CCC-ACS

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in patients with chronic kidney disease (CKD) and acute coronary syndrome (ACS). This study aimed to explore the frequency and impact of AF on clinical outcomes in CKD patients with ACS.

Methods: CKD inpatients with ACS between November 2014 and December 2018 were included based on the improving care for cardiovascular disease in China-ACS (CCC-ACS) project. Included patients were divided into an AF group and a non-AF group according to the discharge diagnosis. Multivariable logistic regression was used to adjust for potential confounders.

Results: A total of 16,533 CKD patients with ACS were included. A total of 1418 (8.6%) patients had clinically recognized AF during hospitalization, 654 of whom had an eGFR of 45 to < 60 ml/min/1.73 m2, and 764 had an estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2. Compared with the non-AF group, the AF group had a higher risk of in-hospital mortality [OR 1.250; 95% CI (1.001-1.560), P = 0.049] and major adverse cardiovascular events (MACEs) [OR 1.361; 95% CI (1.197-1.547), P < 0.001]. We also found that compared with patients with eGFR 45 to < 60 ml/min/1.73 m2, patients with eGFR < 45 ml/min/1.73 m2 had a 1.512-fold increased risk of mortality and a 1.435-fold increased risk of MACEs.

Conclusions: AF was a risk factor affecting the short-term prognosis of ACS patients in the CKD population. Furthermore, the lower the eGFR, the higher the risk of in-hospital mortality and MACEs in CKD patients with ACS.

Trial registry: Clinicaltrial.gov, NCT02306616. Registered 29 November 2014, https://ichgcp.net/clinical-trials-registry/NCT02306616?term=NCT02306616&draw=2&rank=1.

Keywords: Acute coronary syndrome; Atrial fibrillation; Chronic kidney disease.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Prevalence of in-hospital outcomes in patients with or without AF. *P < 0.001. AF atrial fibrillation, MACEs major adverse cardiovascular events

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