Newly Diagnosed Atrial Fibrillation in Acute Myocardial Infarction

Abstract

Background It remains controversial whether long‐term clinical impact of newly diagnosed atrial fibrillation (AF) in the acute phase of acute myocardial infarction (AMI) is different from that of prior AF diagnosed before the onset of AMI. Methods and Results The current study population from the CREDO‐Kyoto AMI (Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction) Registry Wave‐2 consisted of 6228 patients with AMI who underwent percutaneous coronary intervention. The baseline characteristics and long‐term clinical outcomes were compared according to AF status (newly diagnosed AF: N=489 [7.9%], prior AF: N=589 [9.5%], and no AF: N=5150 [82.7%]). Median follow‐up duration was 5.5 years. Patients with newly diagnosed AF and prior AF had similar baseline characteristics with higher risk profile than those with no AF including older age and more comorbidities. The cumulative 5‐year incidence of all‐cause death was higher in newly diagnosed AF and prior AF than no AF (38.8%, 40.7%, and 18.7%, P <0.001). The adjusted hazard ratios (HRs) for mortality of newly diagnosed AF and prior AF relative to no AF remained significant with similar magnitude (HR, 1.31; 95% CI, 1.12–1.54; P <0.001, and HR, 1.32; 95% CI, 1.14–1.52; P <0.001, respectively). The cumulative 5‐year incidence of stroke decreased in the order of newly diagnosed AF, prior AF and no AF (15.5%, 12.9%, and 6.3%, respectively, P <0.001). The higher adjusted HRs of both newly diagnosed AF and prior AF relative to no AF were significant for stroke, with a greater risk of newly diagnosed AF than that of prior AF (HR, 2.05; 95% CI, 1.56–2.69; P <0.001, and HR, 1.33; 95% CI, 1.00–1.78; P =0.048, respectively). The higher stroke risk of newly diagnosed AF compared with prior AF was largely driven by the greater risk within 30 days. The higher adjusted HRs of newly diagnosed AF and prior AF relative to no AF were significant for heart failure hospitalization (HR, 1.73; 95% CI, 1.35–2.22; P <0.001, and HR, 2.23; 95% CI, 1.82–2.74; P <0.001, respectively) and major bleeding (HR, 1.46; 95% CI, 1.23–1.73; P <0.001, and HR, 1.36; 95% CI, 1.15–1.60; P <0.001, respectively). Conclusions Newly diagnosed AF in AMI had risks for mortality, heart failure hospitalization, and major bleeding higher than no AF, and comparable to prior AF. The risk of newly diagnosed AF for stroke might be higher than that of prior AF.

The Impact of the Duration of Cardiac Troponin I Elevation on the Clinical Prognosis as Well as Incidence of New-Onset Atrial Fibrillation Respectively in Elderly Non-ST-Elevation Acute Myocardial Infarction Patients without PCI

“…3,4 Moreover, once patients with AMI are combined with NOAF, it often means a worse prognosis, which deserves high attention and strengthened management. 2,5,6 The latest literature reported that the incidence of NOAF in AMI patients undergoing emergency PCI was 7.9%, 7,8 but, in elderly patients aged 75 years or older with NSTE-AMI without PCI, it remains unclear how the incidence of NOAF and whether the continuous increase in TnI increases the incidence of atrial fibrillation.…”

Electrocardiographic changes in acute myocardial infarction with acute occlusion of all triple coronary arteries

“…What's more, ST‐segment elevation in 15 leads, especially anterior wall myocardial infarction accompanied by CRBBB (Widimsky et al, 2012), indicated a large infarct area in the anterior wall of the left ventricle. And newly diagnosed atrial fibrillation, caused by simultaneous dysfunction of ventricle and atrium, suggested the four cardiac chambers were affected due to the acute occlusion of multiple coronaries (Obayashi et al, 2021). And, it was confirmed by the echocardiography with an LVEF of 22%.…”

Meta‑analysis of the efficacy and safety of nifekalant in the conversion of atrial fibrillation

“…Therefore, early paroxysmal AF should be reversed as early as possible. Patients with persistent AF should receive regular anticoagulation treatment and, if necessary, interventional therapy may be provided (31,32). Pharmacological conversion is the most traditional and classical treatment for patients with AF for restoring the SR of the heart (33).…”

“…Therefore, early paroxysmal AF should be reversed as early as possible. Patients with persistent AF should receive regular anticoagulation treatment and, if necessary, interventional therapy may be provided ( 31 , 32 ).…”