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A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome

  • Acute Coronary Syndrome (J. Hollander and A.M. Chang, Section Editors)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Patients with co-morbid acute coronary syndromes (ACS) and atrial fibrillation (AF) are less likely to receive appropriate therapies and more likely to experience adverse outcomes than those in sinus rhythm. This review of current research findings on the bidirectional relationship between AF and ACS encompasses risk factors for one disease progressing to the other, corresponding patient outcomes, and important implications for clinicians.

Recent findings

Clinicians may be able to stratify ACS patients by clinical characteristics, diagnostic tests, and gender to identify those at increased risk for development of AF. There is evidence for differing treatment efficacy among oral anticoagulant regimens in patients with comorbid AF and ACS. Recent research suggests AF is a risk factor for development of acute coronary syndromes, specifically myocardial infarction, and is a marker for greater disease severity (e.g, ACS, heart failure, renal failure) compared to those in sinus rhythm.

Summary

Initiation and maintenance of antithrombotic regimens in high-risk patients with comorbid AF and ACS is crucial, but not currently routine. The evidence for additional therapies for interrupting their bidirectional relationship is based on observational studies rather than randomized clinical trials, systematic reviews, or meta-analyses. Future research should investigate prevention of AF in ACS and vice versa, and subsequent effects on morbidity and mortality.

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Papers of particular interest, published recently, are highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Emergency Medicine, Oregon Health & Science University, School of Medicine, 3181 SW Sam Jackson Park Road, MC CR114, Portland, OR, 97239-3098, USA

    Bory Kea & Tahroma Alligood

  2. Oregon Health & Science University, School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Vincent Manning

  3. Department of Public Health & Preventive Medicine, Oregon Health & Science University-Portland State University, School of Public Health, 3181 SW Sam Jackson Park Road, MC CR114, Portland, OR, 97239-3098, USA

    Tahroma Alligood

  4. Oregon Health and Science University, Portland, OR, 97239-3098, USA

    Merritt Raitt

  5. Electrophysiology Service, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA

    Merritt Raitt

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  1. Bory Kea
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Kea, B., Manning, V., Alligood, T. et al. A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome. Curr Emerg Hosp Med Rep 4, 107–118 (2016). https://doi.org/10.1007/s40138-016-0105-2

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