Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission

Abstract

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and contributes to high rates of in-hospital adverse events. However, there are few contemporary studies examining rates of AF in the contemporary era of AMI or the impact of new-onset AF on key in-hospital and post-discharge outcomes. We examined trends in AF among 6,384 residents of Worcester, Massachusetts who were hospitalized with confirmed AMI during 7 biennial periods between 1999 and 2011. Multivariate logistic regression analysis was used to examine associations between occurrence of AF and various in-hospital and post-discharge complications. The overall incidence of AF complicating AMI was 10.8%. Rates of new-onset AF increased from 1999 to 2003 (9.8% to 13.2%), and declined thereafter. In multivariable adjusted models, patients developing new-onset AF following AMI were at higher risk for inhospital stroke [Odds Ratio (OR) 2.5, 95% Confidence Interval (CI) 1.6–4.1], heart failure [OR 2.0, 95% CI 1.7 to 2.4], cardiogenic shock [OR 3.7, 95% CI 2.8–4.9] and death [OR 2.3, 95% CI 1.9 to 3.0] than patients without AF. Development of AF during hospitalization for AMI was associated with higher rates of readmission within 30-days after discharge [21.7% vs. 16.0%], but no significant difference was noted in early post-discharge 30-day all-cause mortality rates [8.3% vs. 5.1%]. In conclusion, new-onset AF following AMI is strongly related to in-hospital complications of AMI as well as higher short-term readmission rates.

The antithrombotic therapy of atrial fibrillation in patients with coronary heart disease

“…It is also noted that this arrhythmia is associated with a higher risk of death in the hospital and repeated hospitalizations within 30 days. Moreover, during hospitalization in patients with AMI and AF the risk of acute cerebrovascular accident increases twice [15]. These results are relevant to the GRACE study, which noted that patients with ACS and newly developed AF have a 3 times increased risk of death during hospitalization compared to those without arrhythmia [16].…”

“…These results are relevant to the GRACE study, which noted that patients with ACS and newly developed AF have a 3 times increased risk of death during hospitalization compared to those without arrhythmia [16]. In addition, these patients were almost twice as likely to have complications in the form of heart failure, and more than 3 times more often -in the form of cardiogenic shock [15]. In a large single-center study, while comparing the results of different types of AF, among 2,980 patients with AMI, only with a constant and newly developed form of AF, a significantly higher short-term and long-term mortality was noted, compared with patients without arrhythmia.…”

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

“…In non-dialysis patients who experienced AMI, AF is a common complication associated with adverse outcomes [30,31]. Also, non-dialysis patients with pre-existing AF have increased risk of AMI [32].…”

Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease

“…Также отме-чено, что данная аритмия связана с более вы-соким риском смерти в стационаре и повтор- ными госпитализациями в течение 30 сут. Бо-лее того, во время госпитализации у пациентов с ОИМ и ФП в 2 раза увеличивается риск раз-вития острого нарушения мозгового кровооб-ращения [15]. Эти результаты соответствуют данным исследования GRACE, в котором по-казано, что у больных с острым коронарным синдромом и впервые развившейся ФП риск смерти во время госпитализации повышается в 3 раза по сравнению с теми, у кого нет арит-мии [16].…”

“…Эти результаты соответствуют данным исследования GRACE, в котором по-казано, что у больных с острым коронарным синдромом и впервые развившейся ФП риск смерти во время госпитализации повышается в 3 раза по сравнению с теми, у кого нет арит-мии [16]. Кроме того, эти пациенты почти в 2 раза чаще имели осложнения в виде сердеч-ной недостаточности и более чем в 3 раза ча-ще -в виде кардиогенного шока [15]. В круп-ном одноцентровом исследовании при сравне-нии результатов течения различных типов ФП среди 2980 больных ОИМ только при постоян-ной и впервые развившейся форме отмечена значительно более высокая краткосрочная и долгосрочная летальность по сравнению со случаями без аритмии.…”