The incidence and risk factor of atrial fibrillation after percutaneous coronary intervention.

Abstract

Background: Patients with coronary artery disease and atrial fibrillation (AF) have poor clinical outcomes. However, the incidence of new-onset AF occurring after hospital discharge following percutaneous coronary intervention (PCI) has not been well characterized. The aim of this study was to investigate the incidence and risk factors of AF developing after PCI discharge.

Methods: Patients undergoing PCI enrolled from January 2013 to December 2013. The primary endpoint was new-onset AF occurring after hospital discharge following PCI, defined as AF documented during follow-up and not present during the index PCI hospitalization. Cox proportional hazards regression models with covariate adjustments, complemented by Fine-Gray competing risk analyses, were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for assessing AF risk factors.

Results: Among 8,367 patients, 94 (1.1%) developed new-onset AF during 3-year follow-up, with no significant incidence difference between acute/chronic coronary syndromes (1.1% vs. 1.2%, P = 0.59). Age > 56.5 years (HR 2.97, 95%CI 1.72-5.12) and prior PCI (HR 1.73, 95%CI 1.13-2.65) independently predicted AF. Recalibration modestly improved all scores (the Postoperative Atrial Fibrillation score, CHA2DS2-VASc score, Atrial Fibrillation Risk Index, CHARGE-AF score) without statistical significance. CHARGE-AF outperformed other scores (all P < 0.05), while an age/ prior PCI-only model demonstrated non-inferior predictive capability versus CHARGE-AF.

Conclusions: In this large PCI cohort, a simplified model using only age > 56.5 years and prior PCI demonstrated non-inferior AF prediction compared to the best-performing CHARGE-AF score, supporting streamlined risk stratification for new-onset AF.