The Association of Atrial Fibrillation Before Percutaneous Coronary Intervention With 1-Year Outcome in ST-Elevation Myocardial Infarction Patients

Abstract

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Coronary Embolism in ST‐Segment–Elevation Myocardial Infarction and Atrial Fibrillation: Not One Size Fits All

“…In the study by Popovic et al, 8 CE was detected in 122 (5%) patients of the entire STEMI population, Of these patients, 225 (9.8%) had concomitant AF at time of STEMI presentation, which is consistent with previous reports of prevalence between 4% and 11%. 2 , 3 , 4 , 5 , 6 In this unique population, one fifth (n=46, 20%) had CE identified as the culprit. Compared with those without AF, the population of patients with AF and CE were older, were more frequently women, and more frequently presented with cardiogenic shock at initial presentation and concomitant stroke.…”

“…The majority of the evidence demonstrates that preexisting AF was an independent risk factor with >4‐fold increase in the short‐ and long‐term mortality rate. 4 , 10 , 11 It is plausible that a major contributing element to these poorer outcomes would be the underappreciated embolic phenomenon in patients with AF presenting with STEMI.…”

“…Among the subpopulation with AF, rates of the primary outcome were 19.3% in the thrombectomy group and 15.5% in the PCI alone group, though this was not a statistically significant difference. 4 …”

“… 1 Atrial fibrillation (AF) is a commonly associated arrythmia in STEMI seen in roughly 4% to 11% of this population. 2 , 3 , 4 , 5 , 6 …”

“…The increased risk of death and stroke among the unique population with concomitant STEMI and AF have been previously well documented in several large randomized trials and national registries. 2 , 3 , 4 There is consensus that AF portends a higher risk of poorer outcomes in this population. Although rapid AF can result in insufficient increase in coronary blood flow to meet myocardial metabolic demand, there has been limited investigation into the potential mechanistic causes within coronary circulation that could contribute to these outcomes.…”