Shmuel Chen

New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial

BACKGROUNDnThere is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left mainxa0coronary artery disease (LMCAD).nnnOBJECTIVESnThis study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes.nnnMETHODSnIn the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI withxa0everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF duringxa0thexa0initial hospitalization following revascularization.nnnRESULTSnAmong 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5xa0days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (pxa0< 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantlyxa0longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; pxa0< 0.0001). Byxa0multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjustedxa0hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; pxa0=xa00.001), death (11.4% vs. 4.3%; adjustedxa0HR: 3.02; 95% CI: 1.60 to 5.70; pxa0=xa00.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; pxa0=xa00.0004).nnnCONCLUSIONSnIn patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versusxa0Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776).

Prognostic implications of Q waves at presentation in patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: An analysis of the HORIZONS‐AMI study

Presence of Q waves on the presenting electrocardiogram (ECG) in patients with ST‐segment elevation myocardial infarction (STEMI) has been associated with worse prognosis; however, whether the prognostic value of Q waves is influenced by baseline characteristics and/or rapidity of revascularization based on the guideline‐based metric of door‐to‐balloon time remains unknown.