Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction

Ašanin, Milika; Peruničić, Jovan; Mrdović, Igor; Matić, Milan; Vujisić-Tešić, Bosiljka; Arandjelović, Aleksandra; Vasiljević, Zorana; Ostojić, Miodrag

doi:10.1016/j.ejheart.2004.07.018

Cited by 63 publications

(67 citation statements)

References 17 publications

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“…A detailed description of this population has been reported previously. 1 The present study focused on patients who survived AMI-260 patients with new-onset AF and 292 patients without new-onset AF. Acute myocardial infarction was diagnosed by clinical, echocardiogram (ECG), and enzymatic findings.…”

Section: Population Of the Studymentioning

confidence: 99%

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The Long‐Term Risk of Stroke in Patients with Acute Myocardial Infarction Complicated with New‐Onset Atrial Fibrillation

Milika

Zorana

Mihailo

et al. 2009

Clinical Cardiology

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Background:The long-term risk of stroke after acute myocardial infarction (AMI) complicated with new-onset atrial fibrillation (AF) remains unclear. The aim of this study was to determine the long-term risk of AF and stroke in patients with AMI complicated with new-onset AF. Methods: Patients with AMI complicated with new-onset AF (n = 260) and those without new-onset AF (n = 292) were followed for a mean of 7 years. All patients had sinus rhythm at hospital discharge. Results: During the follow-up, AMI patients with new-onset AF had more frequent AF than those without new-onset AF (10.4% vs 2.7%, respectively; P < 0.0001). New-onset AF during AMI was a significant predictor of subsequent AF occurrence (the time elapsing between 2 consecutive R waves [RR] = 3.15, P = 0.004); but AF recurrence in follow-up (RR = 5.08, P = 0.001) and non-anticoagulation at discharge (RR = 0.29, P = 0.008) were independent predictors of stroke (Cox regression analysis). A period of 3.5 hours of AF within the first 48 hours of AMI was the high sensitivity cut-off level for the prediction of low long-term risk of stroke obtained by receiver operating characteristic analysis. Among patients who did not receive anticoagulants at discharge, the patients with short AF did not experience stroke and AF recurrence during follow-up, while those in the other group developed it (10.8%, P = 0.038 and 13.5%, P = 0.019, respectively). Conclusion: New-onset AF during AMI identifies the patients at long-term risk for stroke who may potentially benefit from anticoagulant therapy. Atrial fibrillation recurrence in follow-up was independently related to the development of stroke. However, for low-risk patients with AF (those with short AF occurring early in AMI) long-term anticoagulants might not be required.

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Section: Population Of the Studymentioning

confidence: 99%

“…5 The occurrence of new-onset AF reflects a poor clinical profile suggesting higher risk in patients with AMI. 2 -8 Mostly, newonset AF in its paroxysmal form complicates AMI, 1,8 and it may be recurrent in the postinfarction period. However, little is known about subsequent AF prognosis in these patients.…”

Section: Introductionmentioning

confidence: 99%

The Long‐Term Risk of Stroke in Patients with Acute Myocardial Infarction Complicated with New‐Onset Atrial Fibrillation

Milika

Zorana

Mihailo

et al. 2009

Clinical Cardiology

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“…The occurrence of newonset AF has been reported to be around 10% in the setting of acute myocardial infarction (AMI) with and without reperfusion therapy. [1][2][3][4] In the current study, the incidence of AF was found to be 10.9% (85/783). Therefore, the finding of the current study was consistent with the findings of previous studies.…”

Section: Discussionmentioning

confidence: 98%

“…Therefore, the finding of the current study was consistent with the findings of previous studies. [1][2][3][4] The causal etiologies of AF in the setting of AMI that have been fully established include atrial ischemia or infarction, pericardial inflammation, acute hypoxia or electrolytemetabolic imbalance, and hemodynamic impairment secondary to left ventricular dysfunction. [18][19][20][21] Additionally, endogenous or exogenous catecholamines may also contribute to AF.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Numerous studies have previously established that AF can cause hemodynamic deterioration. A variant ventricular rate followed by irregular ventricular filling and reduced cardiac output that resulted from a lost contribution of atrial click have been proposed as the mechanisms of hemodynamic deterioration.…”

Section: T He Incidence Of New-onset Atrial Fibrillation (Af) Is Re-mentioning

confidence: 99%

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

et al. 2011

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SummaryThis study evaluated the association between atrial fibrillation (AF) and 30-day clinical outcome in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Between January 2005 and October 2009, 783 consecutive patients with acute STEMI undergoing primary PCI were enrolled. Of these patients, 85 (10.9%) with AF during admission were categorized into group 1, while the remaining 698 (89.1%) with sinus rhythm during admission served as group 2. The results demonstrated that the incidence of advanced Killip score (defined as ≥ score 3) and advanced congestive heart failure (defined as ≥ NYHA class 3) were significantly higher, whereas the left ventricular ejection fraction (LVEF) was notably lower in group 1 than in group 2 (all P < 0.003). Additionally, the normal blood flow in the infarct-related artery was notably lower in group 1 than in group 2 (P = 0.003). Moreover, the incidences of new-onset stroke and 30-day mortality were remarkably higher in group 1 than in group 2 (all P < 0.003). Furthermore, Kaplan-Meier analysis demonstrated that the 30-day survival rate was markedly lower in AF patients than in those with sinus rhythm. However, multivariate stepwise Cox regression analysis demonstrated that the advanced Killip score and low LVEF were significantly and independently predictive of 30-day mortality (all P < 0.004). In conclusion, AF was significantly associated with 30-day mortality. (Int Heart J 2011; 52: 153-158)

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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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Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction

Cited by 63 publications

References 17 publications

The Long‐Term Risk of Stroke in Patients with Acute Myocardial Infarction Complicated with New‐Onset Atrial Fibrillation

The Long‐Term Risk of Stroke in Patients with Acute Myocardial Infarction Complicated with New‐Onset Atrial Fibrillation

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

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

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