Abstract 4141539: Impact of Left Ventricular End-Diastolic Diameter on the Prognosis in Patients with Atrial Fibrillation and Acute Coronary Syndrome or Undergoing PCI

Introduction: Atrial fibrillation (AF) is a common cardiac arrhythmia, the risk of cardiovascular adverse outcome rises when it coexists with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Studies have shown that an increased left ventricular end-diastolic diameter (LVEDD) is associated with worse outcomes in various cardiovascular conditions, including heart failure, and coronary artery disease (CAD). In patients with AF, an enlarged LVEDD may indicate underlying left ventricular dysfunction and structural heart disease, which could potentially predispose to myocardial fibrosis if patients are combined with ACS. Therefore, it is essential to research the impact of LVEDD on the prognosis of patients combined with AF and ACS or PCI. Hypothesis: We hypothesized that LVEDD could be a risk factor for adverse outcomes in AF patients with ACS/PCI. Aims: This study aimed to explore the impact of LVEDD on the major adverse cardiovascular events (MACEs) in patients with AF and ACS or undergoing PCI. Methods: This study consecutively included a total of 2,182 patients with atrial fibrillation combined with ACS or undergoing PCI from 2017 to 2019. The primary endpoint was MACEs, which represented a composite event of all-cause death, stroke, systemic embolism, and massive hemorrhage. Results: The 2,182 patients were divided into two groups: LVEDD＞60mm group (n=370) and LVEDD ≤60 mm group (n=1812). During a median follow-up of 36 months, patients in LVEDD＞60 mm group had a higher incidence of MACEs ( 39.7% vs. 26.0%), Compared with the LVEDD ≤60 mm group. The Kaplan-Meier curves (Figure 1) compared by the log-rank test showed that patients with LVEDD＞60 mm were associated with a higher risk of MACEs (P＜0.001). In Table 1, LVEDD as a continuous variable and LVEDD＞60 mm was independently associated with increased risk of MACEs after adjusting age, sex, BMI, AF type, CAD type, PCI, coronary artery bypass graft, prior myocardial infarction, prior heart failure, prior hypertension, prior diabetes mellitus, troponin I, antiplatelet drugs, anticoagulant drugs, statins in Model 3. The restrictive cubic spline in Figure 2 showed that LVEDD greater than 60 mm increased the risk of MACEs. An LVEDD less than 60 mm seemed to be safe for such patients. Conclusions: LVEDD can be a predictor for MACEs in patients with AF combined with ACS or undergoing PCI. Furthermore, left ventricular dilation indicates a worse prognosis for these patients.