The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction

Pedersen, Ole Dyg; Bagger, Henning; Køber, Lars; Torp-Pedersen, C.

doi:10.1053/euhj.1998.1352

Cited by 211 publications

(159 citation statements)

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“…In previous studies, AF was frequently associated with advanced age in patients with MI. 8,17 Atrial fibrillation in the elderly may be related to the increased incidence of agerelated coexisting pathologic changes in the noninfarcted myocardium and atrial tissue. In patients with AMI, the multiple etiological factors of atrial arrhythmias have been documented.…”

Section: Discussionmentioning

confidence: 99%

Association Between Serum C‐reactive Protein Elevation and Atrial Fibrillation After First Anterior Myocardial Infarction

Gedikli¹,

Örem²,

Baykan³

et al. 2008

Clinical Cardiology

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Background: Elevated inflammatory markers have been found to correlate with higher risk for cardiac events in patients with acute myocardial infarction (AMI). It has been suggested that C-reactive protein (CRP) may be involved in the initiation process of atrial fibrillation (AF). However, the role of CRP levels in the occurence of AF in patients with AMI has not been studied. This study investigated whether CRP is a risk factor for AF in patients with acute anterior MI. Methods: We prospectively evaluated 92 consecutive patients (25 women and 67 men; aged 58±11 y) with a first acute anterior wall MI. Blood samples were obtained at the time of admission to the hospital, and serum CRP levels were measured by an ultrasensitive immunonephelometry method. All patients were evaluated by echocardiography to measure the left ventricular (LV) diameter and functions. All patients were monitored continuously for the detection of AF in the coronary care unit. Results: Atrial fibrillation occured in 19 (20%) of 92 patients. Univariate analysis showed that patients with AF had an advanced age (63±9.9 versus 56.7±11.7 y, p = 0.034), higher serum CRP level (2.95±2.5 versus 1.71±2.12 mg/dL, p = 0.034), larger LV end-systolic volume (74±15 versus 63±19, mL p = 0.02), higher LV ejection fraction (31.1±6.2 versus 38.4±10%, p = 0.001), and larger left atrial (LA) diameter (37.1±4.2 versus 34.7±3.3 mm, p = 0.01). In multivariate analysis, only age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1-1.11, p = 0.036) and CRP levels (OR: 1.27, 95% CI: 1-1.59, p = 0.039) were independent predictors of AF. Conclusion: These results suggest that CRP may be a risk factor for AF in patients with acute anterior wall MI.

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Section: Discussionmentioning

confidence: 99%

Association Between Serum C‐reactive Protein Elevation and Atrial Fibrillation After First Anterior Myocardial Infarction

Gedikli¹,

Örem²,

Baykan³

et al. 2008

Clinical Cardiology

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“…5) As compared with AMI patients with normal sinus rhythm, AMI patients with new-onset AF have been shown to have worse baseline characteristics, more complicated hospital courses, and unfavorable clinical outcomes such as higher incidences of advanced congestive heart failure (CHF), cardiac embolic stroke, and mortality. 1,[6][7][8][9][10]) Surprisingly, all of these studies were conducted in the prethrombolytic or thrombolytic eras. 1,[6][7][8][9][10] Evidence-based medicine has demonstrated that primary percutaneous coronary intervention (PCI) is superior to thrombolytic therapy in terms of increasing the successful reperfusion rate, reducing the incidences of recurrent ischemia and reinfarction, and improving prognostic outcome in patients with acute ST-segment elevation myocardial infarction (STEMI).…”

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

confidence: 99%

“…1,[6][7][8][9][10]) Surprisingly, all of these studies were conducted in the prethrombolytic or thrombolytic eras. 1,[6][7][8][9][10] Evidence-based medicine has demonstrated that primary percutaneous coronary intervention (PCI) is superior to thrombolytic therapy in terms of increasing the successful reperfusion rate, reducing the incidences of recurrent ischemia and reinfarction, and improving prognostic outcome in patients with acute ST-segment elevation myocardial infarction (STEMI). [11][12][13][14] Additionally, one previous study has found that AF was not a significantly independent predictor for short-and long-term outcomes after PCI in the setting of chest pain syndrome.…”

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

confidence: 99%

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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“…Esse tipo de arritmia tem incidência que varia de 10%-22% entre os pacientes na evolução do infarto agudo do miocárdio, sendo muito mais comum entre os idosos 459 e aqueles com disfunção ventricular 460 .…”

Section: -Fibrilação Ou Flutter Atrialunclassified

Diretrizes

2009

Arq. Bras. Cardiol.

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-Atendimento pré-hospitalarO interesse no atendimento pré-hospitalar do infarto agudo do miocárdio (IAM) teve início na década de 1960, devido ao grande número de óbitos que ocorriam antes que os paciente chegassem ao hospital.A maioria das mortes por IAM ocorre nas primeiras horas de manifestação da doença, sendo 40%-65% dos casos na primeira hora e, aproximadamente, 80% nas primeiras 24 horas [1][2][3] . Assim, a maior parte das mortes por IAM acontece fora do ambiente hospitalar, geralmente desassistidas pelos médicos 4 . A modalidade mais frequente de parada cardiorrespiratória nas primeiras horas do IAM é a fibrilação ventricular 3 . -Período pré-hospitalar.O período pré-hospitalar compreende dois momentos: a) do início dos sintomas (geralmente dor torácica aguda) até a decisão de procurar atendimento; b) da decisão de procurar atendimento até a chegada ao hospital.No infarto agudo do miocárdio com elevação do segmento ST (IAMCST), o tempo desde o início dos sintomas (oclusão da artéria coronária) até a instituição do tratamento (reperfusão química ou mecânica) é diretamente proporcional à ocorrência de eventos clinicamente relevantes. Esse tempo é fator fundamental para o benefício do tratamento, tanto imediato quanto tardio 5 .No entanto, sabe-se que a fase pré-hospitalar (em ambos os momentos descritos) é caracterizada por ser demorada, especialmente em pacientes idosos, do sexo feminino e com baixa condição socioeconômica 4 . Alguns fatores estão relacionados ao aumento desse tempo tão precioso (Quadro 1.1.1.1) 6 . O componente pré-hospitalar no atraso do atendimento ao paciente com dor torácica é de tal magnitude que, na prática clínica, apenas cerca de 20% destes pacientes chegam ao setor de emergência com até duas horas após o início dos sintomas 7 . -Medidas na fase pré-hospitalarApesar da significativa redução da mortalidade hospitalar do IAM nas últimas décadas 8,9 , houve pouco avanço no conhecimento sobre a epidemiologia e o tratamento na fase pré-hospitalar. É notória a necessidade de mudanças nesse cenário, embora poucas sejam as evidências geradas para este fim.A abordagem do paciente com suspeita de síndrome coronária aguda em ambiente extra-hospitalar deve, idealmente, ser feita por profissional de saúde, com realização de uma história clínica direcionada, investigando as características dos sintomas atuais (momento do início, tempo de duração, qualidade, intensidade, relação com o esforço e repouso) e a presença de doença coronária estabelecida (angina prévia). Algumas características são reconhecidamente determinantes para a manifestação atípica de um evento coronariano e devem ser lembradas quando um indivíduo for abordado na fase pré-hospitalar, por mascararem o quadro de IAM (Tabela 1.1.2.1) [10][11][12] .O eletrocardiograma executado no local de atendimento e interpretado por um médico habilitado (na ambulância ou em local remoto) mostrou ser um método que reduz em 34% o tempo porta-agulha e em 18% o tempo porta-balão, além de proporcionar maiores taxas de tempo porta-balão ideal (men...

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The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction

Abstract: Atrial fibrillation/-flutter often occurs after acute myocardial infarction and our analysis demonstrated that it was an independent predictor of an increased short and long-term mortality.

Cited by 211 publications

References 0 publications

Association Between Serum C‐reactive Protein Elevation and Atrial Fibrillation After First Anterior Myocardial Infarction

Association Between Serum C‐reactive Protein Elevation and Atrial Fibrillation After First Anterior Myocardial Infarction

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

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