Objective

To summarize data on the prevalence/incidence, risk factors and prognosis of atrial fibrillation (AF) in patients with acute coronary syndromes (ACS).

Methods

MEDLINE, Embase, and Web of Science were searched to identify all published studies providing relevant data through August 23, 2020. Random-effects meta-analysis method was used to pool estimates.

Results

We included 109 studies reporting data from a pooled population of 8,239,364 patients. The prevalence rates were 5.8% for pre-existing AF, 7.3% for newly diagnosed AF, and 11.3% for prevalent (total) AF, in patients with ACS. Predictors of newly diagnosed AF included age (per year increase) (adjusted odds ratio [aOR] 1.05), C-reactive protein (aOR 1.49), left atrial (LA) diameter (aOR 1.08), LA dilatation (aOR 2.32), left ventricular ejection fraction <40% (aOR 1.82), hypertension (aOR 1.87), and Killip ˃1 (aOR 1.85), p<0.01 in all analyses. Newly diagnosed AF was associated with an increased risk of acute heart failure (aHR 3.20), acute kidney injury (aHR 3.09), re-infarction (aHR 1.96), stroke (aHR 2.15), major bleeding (aHR 2.93), and mortality (aHR 1.80) in the short term; and with an increased risk of heart failure (aHR 2.21), stroke (aHR 1.75), mortality (aHR 1.67), CV mortality (aHR 2.09), sudden cardiac death (aHR 1.53), and a composite of major adverse cardiovascular events (aHR 1.54) in the long term (beyond 1 month), p<0.05 in all analyses.

Conclusion

One in nine patients with ACS has AF, with a high proportion of newly diagnosed AF. Atrial fibrillation, in particular newly diagnosed AF, is associated with poor short-term and long-term outcomes in patients with ACS.

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