Table 1.

Major Studies Published from 2011–2015 regarding the ACS-AF relationship

Authors, Year	Study Name/Study Design	Years Studied/Follow Up (Yrs)	Study Population	Major Findings
Predicting Occurrence of ACS in AF
Chao et al., 2015 [9]	N/A Registry	2000–2011 5.7±3.6	12 114 AF pts with CHA2DS2-VASc scores of 0 (men) or 1 (women)	AF predicted MI compared to matched controls (HR 2.93 [95% CI 2.21–3.87]). MI risk was higher in men (HR 2.24 [95% CI 1.61–3.11]) after adjustment.
Soliman et al., 2015 [19]	ARIC Prospective	1987–2010 Median 21.6	14 462 participants free of CHD at baseline	AF predicted MI compared to non-AF (HR, 1.63; 95% CI, 1.32–2.02), NSTEMI (HR, 1.80; 95% CI 1.39–2.31) but not STEMI (HR 0.49; 95% CI 0.18–1.34). The association was stronger in women.
Soliman et al., 2014 [8]	REGARDS Prospective	2003–2009 Median 4.5	23 928 participants free of CHD at baseline	MI rates in AF patients were higher than non-AF patients (adjusted HR 1.70 [95% CI, 1.26–2.3]). Women and blacks were at greater risk. Older age did not increase risk.
O’Neal, et al., 2014 [30]	CHS Prospective	1989–2008 Median 12	4608 pts with no evidence of CHD	Presence of AF increased risk of MI (adj. HR: 1.7, 95% CI: 1.4–2.2). Blacks had increased risk compared with whites.
Predicting Occurrence of AF in ACS
Bretler, et al., 2012[61]		1997–2009	32 925 women discharged after MI with no known AF	HRT use decreased risk of new-onset AF in women with prior MI (HR 0.82, [95% CI 0.68–1.00]). Greatest decrease in women ≥ 80 y.o.
Carrero, et al, 2014[74]	SWEDE HEART	2003 – 2010	24 317 MI pts with AF	Warfarin treatment decreased the risk of re-infarction in those with eGFR > 60 and ≤ 15.
Prognostic Effect of AF in ACS
Rene et al., 2014[51]	HORIZON-AMI RCT	2007–2013	3 281 pts with sinus rhythm undergoing PCI	New-onset AF after PCI was an independent predictor of adverse clinical events (HR 1.74, 95% CI 1.30 to 2.34) and major adverse cardiac events (HR 1.73, 95% CI 1.27 to 2.36) at 3 years.
Verdecchia et al., 2014[36]	RE-LY RCT	2005–2009 Median 2.0	10,372 anti-coagulated elderly AF pts	LVH presence increased CV death (HR 2.56, 95% CI 2.14 to 3.06) and MI in elderly AF patients (HR 2.07, 95% CI 1.47 to 2.92).
McManus et al., 2012 [27]	GRACE	2000–2007	59,032 pts hospitalized with an ACS	Patients with AF were less likely than patients without AF to receive evidence-based therapies. Hospital death rates in patients with new-onset and pre-existing AF were 14.5% and 8.9%, compared to 1.2% in those without AF
Almedro-Delia, et al. 2014 [28]	ARIAM Registry	2001–2011	39 237 consecutive pts with ACS	New-onset AF is an independent predictor for in-hospital mortality (HR 1.62, 95% CI 1.09–2.89).
Jabre 2011 [42]	Meta-Analysis	1970–2009	43 studies involving 278,854 subjects	AF increases mortality in pts with acute MI, regardless of its onset being prior to MI (OR 1.28 [95%CI 1.26–1.49]) or after MI (OR 1.46 [95% CI 1.35–1.58])
Angeli et al, 2012 [46]	Meta-Analysis	1967–2010	24 studies involving 235,511 subjects	Mortality was higher in pts with AF (OR 2.00, 95 % CI: 1.93–2.08; P<0.0001). In NAF (OR 3.38 [95% CI 2.98–3.83] and permanent AF (OR 2.01 [95% CI 1.70–2.38]).
Ruff et al., 2014 [84]	REACH Registry Prospective	2003–2009 4	44,518 of 68,236 enrolled in REACH	The prevalence of AF at baseline = 10.3% (n = 4582). Pts with AF had a 2-fold increase in the composite of CV death, MI, or stroke compared with patients without AF after adjustment (18.9%vs. 9.4%, p < 0.0001). Only 52% of patients with a history of AF at baseline were receiving anticoagulation at 4 years.

AF atrial fibrillation, ACS Acute Coronary Syndrome, NAF new onset AF, Pts patients, MI myocardial infarction, HR hazard ratio, CI confidence interval CHD coronary heart disease, CV cerebrovascular, SR sinus rhythm, STEMI ST segment elevation MI, NSTEMI non-ST segment elevation MI, PCI percutaneous coronary intervention, HRT hormone replacement therapy, eGFR estimated glomerular filtration rate