Comparison of clinical characteristics, treatment, in-hospital and 12-month outcomes in patients after myocardial infarction with ejection fraction < 40% with or without atrial fibrillation

Abstract

IntroductionThe study aimed to compare the characteristics, treatment, and 12-month outcomes of patients after myocardial infarction (MI) and with left ventricular ejection fraction (LVEF) &lt; 40%, with or without atrial fibrillation (AF).Material and methodsThe analysis involved 10,222 surviving patients who were enrolled in the ongoing, prospective Polish Registry of Acute Coronary Syndromes (PL-ACS). The major adverse cardiac events (MACE) involved death, non-fatal MI, rehospitalization due to heart failure (HF), and stroke within 12 months after MI.ResultsPatients with AF were older (73.7 [13.1] vs. 68.3 [16.4], p &lt; 0.001) and had a greater prevalence of previous MI (37.3% vs. 32.4%, p = 0.0007), percutaneous coronary intervention (PCI) (27.5% vs. 23.6%, p = 0.002), and HF hospitalization (34.6% vs. 19.7%, p &lt; 0.001). In patients with AF, coronary angiography (87.3% vs. 92.5%, p &lt; 0.001) and PCI (76.8% vs. 82.7%, p &lt; 0.001) were performed less frequently. Patients with AF had a higher rate of all-cause mortality (26.8% vs. 17.4%, p &lt; 0.001), HF hospitalization (35.0% vs. 25.3%, p &lt; 0.001), stroke (5.5% vs. 2.1%, p &lt; 0.001) and MACE (56.2% vs. 42.8%, p &lt; 0.001). In the multivariate analysis, AF was revealed to be associated with a higher all-cause mortality (odds ratio 1.20, 95% confidence interval 1.03–1.40, p = 0.018).ConclusionsPatients after MI with LVEF &lt; 40% and with AF, compared to those without AF, had worse clinical characteristics, were less frequently subjected to coronary angiography and PCI during hospitalization, and had significantly less favorable 12-month outcomes.

Is neural network better than logistic regression in death prediction in patients after ST-segment elevation myocardial infarction?

“…Therefore, it may be concluded that the increase of data sets and the use of more complex variables, such as digital electrocardiograms or diagnostic images, may reveal the superiority of NN over the LR approach [14]. One of the primary purposes of analyses performed in the PL-ACS registry is to identify the clinically significant predictors of unfavorable events and patients with high mortality risk [21][22][23]. The post-STEMI risk stratification is an important clinical issue highlighted in the "Gaps in the evidence and areas for future research" section of the European Society of Cardiology guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation [24].…”