ABC | Volume 113, Nº5, November 2019

Original Article Congo et al. New-Onset atrial fibrillation in STEMI Arq Bras Cardiol. 2019; 113(5):948-957 Figure 2 – Reperfusion therapy. AF: atrial fibrillation; PCI: percutaneous coronary intervention. 83,2 81,9 92,6 97,3 PCI Reperfusion Therapy Fibrinolysis REPERFUSION THERAPY Values are percentage (%) No AF AF 7,4 2,7 Table 3 – Medical therapy during in-hospital stay Values are percentage (%) All Group 1 – No AF Group 2 – New onset AF p Aspirin 98.6 98.6 99.2 0.349 Clopidogrel 86.7 86.6 89.3 0.138 Ticagrelor 17.6 17.9 12.3 0.042 Prasugrel 0 0 0 Other AP 5.4 5.5 5.2 0.859 GPIIbIIIa inhibitors 33.6 33.5 35.8 0.362 UFH 46.3 46.3 45.6 0.784 Fondaparinux 6.1 6.0 7.7 0.185 Bivalirudin 0.7 0.6 0.8 0.512 LMWH 45.1 44.3 58.2 < 0.001 Vitamin K antagonists 1.3 1.0 5.2 < 0.001 NOAC 0.3 0.3 0.8 0.106 Beta-blockers 79.6 80.2 69.5 < 0.001 ACE inhibitors/ARB 86.3 86.6 80.8 0.002 Aldosterone antagonists 13.5 12.6 27.3 < 0.001 Statins 94.6 94.5 95.6 0.364 Diuretics 25.1 23.0 58.5 < 0.001 Amiodarone 6.5 2.9 65.9 < 0.001 Other antiarrhythmic drugs 1.0 0.9 1.9 0.08 Digitalis 0.9 0.3 11.3 < 0.001 Inotropes 7.8 6.6 27.3 < 0.001 Levosimendan 1.0 0.7 5.5 < 0.001 AF: atrial fibrillation; AP: antiplatelet therapy; GpIIb/IIIA inhibitors: Glycoprotein IIb/IIIa inhibitors; LMWH: low molecular weight heparin; UFH: unfractionated heparin. There is insufficient data indicating preferences for rate or rhythm control in AF complicating STEMI. Besides beta-blockers, antiarrhythmic drug use is usually limited to amiodarone. 13 In our population, two-thirds of the patients who developed new onset AF were started on amiodarone. Selection of antithrombotic therapy was at the discretion of the attending physician and reflects a wide range of therapeutic strategies in a “real-life” setting. Considering the most recent guidelines published by the European Society of Cardiology, the recommendation is that STEMI patients with an indication for oral anticoagulation, as in AF, should be considered for triple therapy with aspirin, clopidogrel and oral anticoagulant for 1-6 months. 13,14 As shown in Table 5, in this population, only 16.1% were on triple therapy at discharge, 10.2% with AAS, clopidogrel and vitamin K antagonists, and 5.9% on AAS, clopidogrel and non-vitamin K anticoagulant (NOAC). This low rate of triple therapy in STEMI patients with AF has been reported in other studies, such as the APEX-AMI study, where 10.6% of new-onset AF patients hospitalized for STEMI were on triple therapy. 15 Seventeen percent of patients in group 2 were on P2Y 12 inhibitors other than clopidogrel and none of these were on anticoagulants at discharge. It is noteworthy that 6.1% of patients on aspirin during in-hospital stay were not on aspirin when discharged, suggesting that a WOEST 952