A-73 | Atrial Fibrillation in STEMI Patients: Assessing the Difference in Clinical Outcomes

Background: Atrial fibrillation (A-fib) is a prevalent arrhythmia observed in ST-elevation myocardial infarction (STEMI) patients and is associated with worse outcomes, including increased mortality and complications.Despite its clinical significance, the specific effects of Afib in STEMI patients remain underexplored.Methods: We analyzed the 2020 NIS database retrospectively, identifying STEMI hospitalizations using ICD-10 codes.Patients were divided into those with a history of A-fib (STEMIA-fib) and those without a history of A-fib (STEMInoA-fib), with outcomes including mortality, length of hospital stay (LOS), total hospital charge (TOTCHG), and post-STEMI complications.Outcomes are reported with 95% CI (APC [95%CI]).Results: Among 552,025 STEMI patients, 107,850 (19.5%) had A-fib (STEMIA-fib), and 444,175 (80.4%) had no A-fib (STEMInoA-fib).The average age of STEMIA-fib patients was 73.3 vs. 64.7 years for STE-MInoA-fib.The male-to-female ratio was similar (64.2% vs. 35.8%),with Whites predominating, followed by Blacks and Hispanics.For mortality, 18,334 (4.1%) in STEMInoA-fib vs. 8,564 (7.94%) in STEMIA-fib died, however this was not statistically significant (OR: 0.98, P > 0.63, CI: 0.90 -1.06).LOS was 6.26 days for STEMIA-fib vs. 3.84 days for STEMInoAfib, which was statistically significant (OR: 1.19, P < 0.01, CI: 1.09-1.29).TOTCHG was $144,940 in STEMIA-fib vs. $107,238 in STEMInoA-fib patients, which was statistically significant (OR: 18,846, P < 0.01, CI: 15,734-21,959).Risk and complication analysis showed a 9% and 15% decrease in the odds of diabetes and hypertension, respectively (all P <0.01).There was a 5%, 14%, 15%, 21%, 21%, 25%, 29%, 30%, 35%, 38%, 42%, and 49% increase in the odds of old MI, obesity, ESRD, AKI, cardiac arrest, V-fib, HFrEF, stroke, intracardiac thrombi, SVT, cardiogenic shock and HFpEF respectively (all P<0.01).Conclusions: A-fib in STEMI patients was associated with increased LOS and TOTCHG but no difference in mortality.Post-STEMI complications showed higher odds of cardiac arrest, V-fib, HFrEF, stroke, intracardiac thrombi, SVT, cardiogenic shock, and HFpEF, but no differences in free wall rupture, ventricular septal rupture, post-MI pericarditis, or AV block.