Increased risk of ischemic stroke associated with new-onset atrial fibrillation complicating acute coronary syndrome: A systematic review and meta-analysis

Luo, Jiachen; Li, Hongqiang; Qin, Xiaoming; Liu, Baoxin; Zhao, Jinlong; Maihe, Guli; Li, Zhiqiang; Wei, Yidong

doi:10.1016/j.ijcard.2018.04.096

Cited by 33 publications

(29 citation statements)

References 36 publications

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“…5 Previous studies have shown that the presence of NOAF in the setting of AMI is independently associated with increased risks of death and ischemic stroke. 6,7 Given the fact that a transient NOAF episode is even related to poor outcome, NOAF during AMI should not be perceived as a benign event anymore. 8 AF and HF often coincide in clinical practice, and the reciprocal impact of both conditions on patients' prognosis has been validated in various settings.…”

Section: Introductionmentioning

confidence: 99%

Long‐term impact of new‐onset atrial fibrillation complicating acute myocardial infarction on heart failure

Luo

et al. 2020

ESC Heart Failure

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Aims New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on heart failure (HF) is still not well characterized. We aimed to investigate the relationship between NOAF complicating AMI and HF hospitalization. Methods and results Adult AMI patients identified in the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in Shanghai registry who, discharged alive, had complete echocardiography and follow-up data from February 2014 to March 2018 were included. Patients were divided according to the presence of NOAF. The outcome measures were HF hospitalization and death during the observational period (until 10 April 2019). Cox proportional hazard models were performed in the whole population and propensity score-matched (PSM) cohort to assess the adjusted hazard ratio (HR) and 95% confidence interval (CI). Overall, 2075 patients (mean age: 65.2 ± 12.3 years, 77.3% were men) with AMI were analysed, of whom 228 (11.0%) developed NOAF. Advanced age, admission HF (Killip II-IV), impaired renal function, decreased left ventricular ejection fraction, increased heart rate, and left atrial enlargement were independent predictors of NOAF. Over a median observational period of 2.7 years, the annual incidence rates of HF hospitalization were 18.4% and 2.8% for patients with NOAF and sinus rhythm, respectively. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (HR: 3.14, 95% CI: 2.30-4.28, P < 0.001). Similar results were obtained when accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18-4.30, P < 0.001) or from the PSM cohort (HR: 2.82, 95% CI: 1.99-4.00, P < 0.001). Patients with persistent NOAF (HR: 5.81, 95% CI: 3.59-9.41) were at significantly higher risk of HF hospitalization when compared with those with transient one (HR: 2.61, 95% CI: 1.84-3.70, P interaction = 0.008). Although post-MI NOAF was significantly related to cardiovascular death (annual incidence rates for NOAF and sinus rhythm were 9.4% and 2.3%, respectively; HR: 1.97, 95% CI: 1.36-2.85, P < 0.001), such an association was attenuated when HF hospitalization (modelled as a time-varying covariate) and antithrombotic treatment were adjusted (HR: 1.37, 95% CI: 0.92-2.02, P = 0.121). Conclusions In patients with AMI, NOAF is strongly associated with an increased long-term risk of HF hospitalization. Our findings suggest that strengthened secondary prevention of HF should be considered in this high-risk population.

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Section: Introductionmentioning

confidence: 99%

Long‐term impact of new‐onset atrial fibrillation complicating acute myocardial infarction on heart failure

Luo

et al. 2020

ESC Heart Failure

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“…Irrespective of the underlying etiology, stroke is a major cause of morbidity and mortality and remains the fourth leading cause of death in the United States 1 . It remains one of the feared complications in patients with ST‐elevation myocardial infarction (STEMI) and is associated with higher mortality in comparison to those with no stroke 2,3 . Cardiogenic shock (CS) is a leading cause of death in patients with STEMI despite improvement in early revascularization strategies 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Incidence and clinical outcomes of stroke in ST‐elevation myocardial infarction and cardiogenic shock

Pahuja

Chehab

Ranka

et al. 2020

Cathet Cardio Intervent

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Objective The authors sought to evaluate 10‐year national trends, incidence and clinical outcomes of stroke in CS‐STEMI. Background Stroke is a devastating complication among patients with ST‐elevation myocardial infarction (STEMI). Concomitant cardiogenic shock (CS) may further increase the risk of stroke. Use of percutaneous mechanical circulatory support (pMCS) devices may further increase stroke risk in CS‐STEMI. No studies have evaluated the risk of stroke in contemporary CS‐STEMI. Methods We performed a retrospective cohort study of CS‐STEMI patients from a large U.S. national database between 2005 and 2014. Previously validated codes for stroke were used to identify events of ischemic or hemorrhagic stroke. They were then divided into different groups: without MCS, with intra‐aortic balloon pump, percutaneous ventricular assist device (PVAD, includes Impella or TandemHeart devices), or extracorporeal membrane oxygenation. Results In 172,491 admissions, stroke was noted in 5,613 (3.2%). Between 2005 and 2014, we observed an increase in the events of overall stroke from 3.1% in 2005 to 5.0% in 2014 (p for the trend <.001). The number of ischemic stroke events (2.4%) was higher than hemorrhagic stroke (0.1%) during the study period. Presence of stroke was associated with higher in‐hospital mortality (40.6 vs. 29.8%, 95% CI adjusted odds ratio: 1.57, 1.44–1.67; p < .0001 among stroke vs. without stroke). Conclusions The incidence of stroke events in CS‐STEMI patients increased between 2005 and 2014, and is associated with higher in‐hospital mortality, length of stay, and cost of hospitalization. The incidence of both hemorrhagic and ischemic stroke was higher with pMCS device use. Stroke prevention is a priority for CS‐STEMI patients.

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“…Последующее совершенствование реперфузионного лечения проведением чрескожного коронарного вмешательства (ЧКВ) или коронарного шунтирования (КШ) с последующим продолжительным периодом двойной или тройной антитромботической терапии не привело к значимому снижению частоты развития инсульта. Согласно литературным источникам частота развития ишемического инсульта в течение госпитального этапа лечения ИМ в этот период также составляет примерно 1% [20,21]. Заметное увеличение частоты ишемического инсульта обнаружено в течение первых 30 дней после ИМ, которое в 44 раза превышало таковую в общей популяции [22].…”

Section: частота развития ишемического инсульта у больных инфарктом мunclassified

“…При этом по сравнению с первым месяцем с 31-го дня до 1 года происходил резкий спад заболеваемости инсультом (в 3,1 раза) [6]. Частота развития инсульта через 1 мес после развития ИМ составляет 1,2% [20], в течение года после ИМ инсульт развивается у 1,7-2,1% больных [21,25]. Согласно анализу крупных исследований в течение первого года после ИМ частота развития ишемического инсульта составляет 4,1% [11,23].…”

Section: Myocardial Infarction Complicated By Ischemic Stroke инфарктunclassified

Myocardial Infarction Complicated by Ischemic Stroke: Risk Factors, Prognosis, Unresolved Problems and Possible Methods of Prevention

Зыков¹,

Буцев²,

Suleymanov³

2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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The present work is devoted to the analysis of modern publications on various aspects of the development and course of ischemic stroke in the presence of acute myocardial infarction. A literature search was conducted on the websites of cardiological and neurological societies, as well as on the PubMed, EMBASE, eLibrary databases using the keywords: myocardial infarction, acute coronary syndrome, stroke, acute cerebrovascular accident, myocardial infarction, acute coronary syndrome, stroke. The authors of this review found that although stroke is a relatively rare complication of myocardial infarction, its prevention is an extremely significant task, since it is associated with high mortality, disability and a significant increase in the cost of treatment. So, it is extremely important to detect thrombosis of the left ventricular cavity in a timely manner, to register preexisting atrial fibrillation that occurs earlier or for the first time, followed by the appointment of anticoagulant therapy. Timely reperfusion treatment, the use of statins and modern dual antithrombotic therapy can reduce the risk of developing cerebrovascular accident in patients with myocardial infarction. It is likely that a decrease in the activity of subclinical inflammation after myocardial infarction will also reduce the risk of stroke, as was recently shown in the COLCOT study. Currently, it remains relevant to search for new knowledge about the risk factors for stroke, which complicated the course of myocardial infarction, which will allow developing more effective and personalized preventive measures in a patient with acute coronary syndrome.

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Increased risk of ischemic stroke associated with new-onset atrial fibrillation complicating acute coronary syndrome: A systematic review and meta-analysis

Cited by 33 publications

References 36 publications

Long‐term impact of new‐onset atrial fibrillation complicating acute myocardial infarction on heart failure

Long‐term impact of new‐onset atrial fibrillation complicating acute myocardial infarction on heart failure

Incidence and clinical outcomes of stroke in ST‐elevation myocardial infarction and cardiogenic shock

Myocardial Infarction Complicated by Ischemic Stroke: Risk Factors, Prognosis, Unresolved Problems and Possible Methods of Prevention

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