Abstract 4142533: Ventricular rate of Patients With Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention and the Risk of Adverse Outcomes

Background: Atrial fibrillation (AF) often coexists with acute coronary syndromes (ACS) or conditions requiring percutaneous coronary interventions (PCI), worsening the outcome. Although rate control is a cornerstone in AF management, the optimal rate-control target in patients with AF and ACS or undergoing PCI is not well-investigated. Methods: This study employed a post hoc analysis of a single-center prospective real-world cohort, including patients with AF and ACS or undergoing PCI who were receiving treatment with rate control drugs, from September 2016 to March 2020. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause death. We evaluated the impact of ventricular rate [(<60, 60–79, 80–99, and 100–110, > 110 beats per minute (bpm)] on subsequent adverse outcomes using multivariable Cox regression models. Results: The cohort consisted of 1004 patients with a median age of 68 years and predominantly male (72%). Patients with ventricular rates >110 bpm showed the highest incidence of MACCEs (40.3%), all-cause death (30.6%) and cardiovascular death (24.2%) compared to other groups. Multivariable analysis confirmed that ventricular rates >110 bpm were associated with greater risk of MACCEs (HR, 2.35; 95% CI, 1.38-4.00; P for trend = 0.0178) and all-cause death (HR, 2.64; 95% CI, 1.29-5.40; P for trend =0.0091). Additionally, clear evidence of a dose-response relationship existed between higher ventricular rates and the risks of MACCEs, all-cause death, and cardiovascular death. Conclusion: In patients with AF and ACS or receiving PCI who were managed with rate-control agents, ventricular rates >110 bpm were associated with higher risks of MACCEs and all-cause death.