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The risk for acute coronary syndrome associated with atrial fibrillation among ED patients with chest pain syndromes.

Brown AM, Sease KL, Robey JL, Shofer FS, Hollander JE

Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.

OBJECTIVE: We sought to determine if atrial fibrillation is associated with an increased risk for an acute coronary syndrome (ACS) among emergency department (ED) patients with chest pain syndromes. METHODS: We performed a retrospective analysis of a prospectively collected database on ED patients with chest pain by selecting patients with atrial fibrillation and frequency-matched control subjects without atrial fibrillation. Measured outcomes were acute myocardial infarction (AMI), ACS, and unstable angina (UA). The relative risks of AMI, ACS, and UA associated with atrial fibrillation were calculated. RESULTS: One hundred forty patients with atrial fibrillation and 683 matched control subjects were identified. The rates of AMI for the atrial fibrillation and control groups were 11.4% and 10.8%, respectively; those of ACS were 27.9% and 26.7%, respectively; and those of UA were 16.4% and 15.8%, respectively. The relative risks of AMI and ACS did not increase in patients with atrial fibrillation: AMI, 1.05 (95% confidence interval [CI] = 0.63-1.75); ACS, 1.05 (95% CI = 0.78-1.40); and UA, 1.05 (95% CI = 0.6-1.7). CONCLUSION: Among patients presenting to the ED with chest pain syndromes, atrial fibrillation is not associated with an increased risk for AMI, ACS, and UA.

Published 4 June 2007 in Am J Emerg Med, 25(5): 523-8.
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