Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data

Abstract

Background-Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infarction. Recent advances in pharmacological treatment of myocardial infarction may have changed the impact of this arrhythmia. Objective-To assess the incidence and prognosis of atrial fibrillation complicating myocardial infarction in a large population of patients receiving optimal treatment, including angiotensin converting enzyme (ACE) inhibitors. Methods-Data were derived from the GISSI-3 trial, which included 17 944 patients within the first 24 hours after acute myocardial infarction. Atrial fibrillation was recorded during the hospital stay, and follow up visits were planned at six weeks and six months. Survival of the patients at four years was assessed through census oYces. Results-The incidence of in-hospital atrial fibrillation or flutter was 7.8%. Atrial fibrillation was associated with indicators of a worse prognosis (age > 70 years, female sex, higher Killip class, previous myocardial infarction, treated hypertension, high systolic blood pressure at entry, insulin dependent diabetes, signs or symptoms of heart failure) and with some adverse clinical events (reinfarction, sustained ventricular tachycardia, ventricular fibrillation). After adjustment for other prognostic factors, atrial fibrillation remained an independent predictor of increased in-hospital mortality: 12.6% v 5%, adjusted relative risk (RR) 1.98, 95% confidence interval (CI) 1.67 to 2.34. Data on long term mortality (four years after acute myocardial infarction) confirmed the persistent negative influence of atrial fibrillation (RR 1.78, 95% CI 1.60 to 1.99). Conclusions-Atrial fibrillation is an indicator of worse prognosis after acute myocardial infarction, both in the short term and in the long term, even in an unselected population. (Heart 2001;86:527-532)

The Prognostic Value of Atrial Fibrillation on 30-Day Clinical Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…[6][7][8] Therefore, it is certain that AF is associated with an increased in-hospital mortality after AMI in both the prethrombolytic and thrombolytic eras. 1,[6][7][8][9][10] In the present study, we found that patients with AF have significantly higher incidences of stroke, advanced CHF, advanced Killip score upon presentation, more myocardial damage, notably lower LVEF, and more advanced age than those with sinus rhythm. An important fact is that AF patients had a remarkably lower incidence of successful reperfusion and markedly higher 30-day mortality than those with sinus rhythm undergoing primary PCI.…”

“…5) As compared with AMI patients with normal sinus rhythm, AMI patients with new-onset AF have been shown to have worse baseline characteristics, more complicated hospital courses, and unfavorable clinical outcomes such as higher incidences of advanced congestive heart failure (CHF), cardiac embolic stroke, and mortality. 1,[6][7][8][9][10]) Surprisingly, all of these studies were conducted in the prethrombolytic or thrombolytic eras. 1,[6][7][8][9][10] Evidence-based medicine has demonstrated that primary percutaneous coronary intervention (PCI) is superior to thrombolytic therapy in terms of increasing the successful reperfusion rate, reducing the incidences of recurrent ischemia and reinfarction, and improving prognostic outcome in patients with acute ST-segment elevation myocardial infarction (STEMI).…”

“…1,[6][7][8][9][10]) Surprisingly, all of these studies were conducted in the prethrombolytic or thrombolytic eras. 1,[6][7][8][9][10] Evidence-based medicine has demonstrated that primary percutaneous coronary intervention (PCI) is superior to thrombolytic therapy in terms of increasing the successful reperfusion rate, reducing the incidences of recurrent ischemia and reinfarction, and improving prognostic outcome in patients with acute ST-segment elevation myocardial infarction (STEMI). [11][12][13][14] Additionally, one previous study has found that AF was not a significantly independent predictor for short-and long-term outcomes after PCI in the setting of chest pain syndrome.…”

Prognostic implications of PR-segment depression in inferior leads in acute inferior myocardial infarction

“…Atrial fibrillation is a well-known poor prognostic marker of both short-and long-term mortality in acute MI. 9,22 In this study, the increase in in-hospital mortality was clearly attributed to an increase in the free-wall rupture rate. Whether uncomplicated atrial infarction per se increases short-term mortality is unknown.…”

Angiotensin‐Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Are Associated With Improved Outcome but Do Not Prevent New‐Onset Atrial Fibrillation After Acute Myocardial Infarction

“…In the TRACE trial,38 a lower risk of new‐onset AF was observed among patients discharged with trandolapril. In contrast, the Gruppo Italiano per lo Studio Della Sopravvivenza Nell'Infarto Miocardico‐3 (GISSI‐3) trial39 reported no significant reduction in the risk of new‐onset AF with RAS inhibition. In a meta‐analysis including these 2 trials, no association was observed between RAS inhibition and risk of new‐onset AF in a subgroup of post‐AMI patients 40.…”