Comprehensive Use of Routine Clinical Parameters to Identify Patients at Risk of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

Abstract

(1) Background: New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI). Our study aimed to investigate whether routinely checked clinical parameters aid in NOAF identification in modernly treated AMI patients. (2) Patients and methods: Patients admitted consecutively within 2017 and 2018 to the University Clinical Centre in Gdańsk (Poland) with AMI diagnosis (necrosis evidence in a clinical setting consistent with acute myocardial ischemia) were enrolled. Medical history and clinical parameters were checked during NOAF prediction. (3) Results: NOAF was diagnosed in 106 (11%) of 954 patients and was significantly associated with in-hospital mortality (OR 4.54, 95% CI 2.50–8.33, p < 0.001). Age, B-type natriuretic peptide (BNP), C-reactive protein (CRP), high-sensitivity troponin I, total cholesterol, low-density lipoprotein cholesterol, potassium, hemoglobin, leucocytes, neutrophil/lymphocyte ratio, left atrium size, and left ventricular ejection fraction (LVEF) were associated with NOAF in the univariate logistic analysis, whereas age ≥ 66 yo, BNP ≥ 340 pg/mL, CRP ≥ 7.7 mg/L, and LVEF ≤ 44% were associated with NOAF in the multivariate analysis. (4) Conclusions: NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Simple, routinely checked clinical parameters could be helpful indices of this arrhythmia in current invasively treated patients with AMI.

Use of Anticoagulant Therapy in Patients with Acute Myocardial Infarction and Atrial Fibrillation

“…The results of Gal et al showed an association between hsTnT values measured at different intervals and newly developed AF between 24–72 h as well as 72 h after hospital admission [ 27 ]. Such data are also supported by a recent study by Raczkowska-Golanko et al [ 28 ].…”

“…In addition, according to a study by Raczkowska-Golanko et al, left atrial diameter ≥ 41 mm and LVEF ≤ 44% were significant predictors of newly developed AF in univariate analysis in patients with AMI. EF has also been shown to be significant in multivariate analysis [ 28 ].…”

New-Onset Atrial Fibrillation in Acute Myocardial Infarction Is a Different Phenomenon than Other Pre-Existing Types of That Arrhythmia

“…This study is a sub-analysis of our previous retrospective research, where the recruitment process was precisely described [ 9 ]. The study population consisted of consecutive AMI patients hospitalized in the University Clinical Centre of Gdansk from January 2017 to December 2018.…”

“…All patients were divided into four groups: NOAF (group of patients with any newly diagnosed AF that appeared during AMI hospitalization without a prior diagnosis of AF as it was precisely described [ 9 ]); AF (group of patients with a previously documented diagnosis of AF who additionally had AF during AMI hospitalization); Prior-AF (group of patients with a previously documented diagnosis of AF who had not developed AF during AMI hospitalization); and Non-AF (group of patients with no evidence of AF during AMI hospitalization and without the prior AF diagnosis). …”

“…New-onset AF (NOAF), defined as newly diagnosed AF in AMI, constitutes a particular type of that arrhythmia. According to data from the literature [ 6 , 7 , 8 ] and the results of our previous study [ 9 ], NOAF is connected with worse clinical characteristics and poor outcomes in comparison to other patients with AMI [ 10 ]. However, there is no precise answer to whether NOAF is a more aggravating diagnosis in AMI patients than other types of AF.…”