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Semin Thromb Hemost 2020; 46(08): 887-894
DOI: 10.1055/s-0040-1718397
Review Article

New-Onset Atrial Fibrillation and Adverse In-Hospital Outcome in Patients with Acute Pulmonary Embolism

Ri-Bo Tang   *
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Yan-Yan Jing‡   *
2   Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, People's Republic of China
,
Zhi-Yuan Xu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
2   Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, People's Republic of China
,
Jian-Zeng Dong
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Xin Du
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Jia-Hui Wu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Rong-Hui Yu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
De-Yong Long
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Man Ning
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Cai-Hua Sang
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Chen-Xi Jiang
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Rong Bai
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Nian Liu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Song-Nan Wen
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Song-Nan Li
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Xuan Chen
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Shu-Tao Huang
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Yi-Kai Cui
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Chang-Sheng Ma
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
› Author Affiliations Funding This study was supported by the National Key Research and Development Program of China (2017YFC0908803, 2017YFC0908800, and 2018YFC1312501) and Beijing Municipal Science and Technology Commission (No. Z181100001718105).
› Further Information
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Abstract

Atrial fibrillation (AF) can be secondary to acute pulmonary embolism (PE). This study aimed to investigate the prognostic impact of new-onset AF on patients with acute PE. In this study, 4,288 consecutive patients who were diagnosed with acute PE were retrospectively screened. In total, 77 patients with acute PE and new-onset AF were analyzed. Another 154 acute PE patients without AF were selected as the age- and sex-matched control group. Adverse in-hospital outcome comprised one of the following conditions: all-cause death, endotracheal intubation, cardiopulmonary resuscitation, and intravenous catecholamine therapy. The patients with new-onset AF had higher prevalence of congestive heart failure, higher simplified PE severity index (sPESI), higher creatinine, and larger left atrium diameter. The incidences of adverse in-hospital outcomes were 10.4 and 2.6% in patients with new-onset AF and no AF, respectively (p = 0.02). Patients with sPESI ≥ 1 had higher incidence of adverse in-hospital outcomes than those with sPESI = 0 (9.4 vs. 0.9%, p < 0.01). The area under the receiver operating characteristic curve of sPESI and sPESI + AF (adding 1 point for new-onset AF) scores in assessing the adverse in-hospital outcome were 0.80 (95% confidence interval [CI]: 0.68–0.93) and 0.84 (95% CI: 0.72–0.96), respectively. In multivariable analysis, sPESI ≥ 1 (odds ratio, 8.88; 95% CI: 1.10–72.07; p = 0.04) was an independent predictor of adverse in-hospital outcome. However, new-onset AF was not an independent predictor. In the population studied, sPESI is an independent predictor of adverse in-hospital outcomes, whereas new-onset AF following acute PE is not, but it may add predictive value to sPESI.

Keywords

pulmonary embolism - PE - atrial fibrillation - AF - prognosis

Role of Sponsors

The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.


* Ri-Bo Tang and Yan-Yan Jing contributed equally and share the first authorship.




Publication History

Article published online:
23 December 2020

© 2020. Thieme. All rights reserved.

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