Transient atrial fibrillation and risk of stroke after acute myocardial infarction

Abstract

Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI). In the AMI setting, AF is frequently brief and attributed to acute haemodynamic changes, inflammation or ischaemia. However, it remains uncertain whether transient AF episodes are associated with a subsequent increased risk of ischaemic stroke. We studied the impact of transient new-onset AF on the one-year risk of ischaemic stroke or transient ischaemic attack (TIA) in a retrospective cohort of 2,402 patients with AMI. Patients with previous AF or AF at hospital discharge were excluded. Transient AF occurred in 174 patients (7.2%) during the initial hospitalisation. During one year follow-up after hospital discharge, stroke or TIA occurred in 16 (9.2%) and 58 (2.6%) patients with and without transient AF, respectively (p< 0.0001). Compared with patients without transient AF, the adjusted hazard ratio for stroke or TIA in patients with transient AF was 3.03 (95% CI 1.73-5.32; p< 0.0001). Stroke or TIA occurred in 2.6% of patients without AF, 6.3% of patients with transient AF treated with oral anticoagulants, and 9.9% of patients with transient AF treated with antiplatelet agents. The incidence of recurrent AF after hospital discharge was markedly higher in patients with transient AF during the index hospitalisation (22.8% vs. 2.0%, p< 0.0001). In conclusion, transient AF complicating AMI is associated with an increased future risk of ischaemic stroke and TIA, particularly in patients treated with antiplatelet agents alone. High AF recurrence rates in these patients also suggest that oral anticoagulants should be strongly considered.

The Relation between Serum Phosphorus Levels and Clinical Outcomes after Acute Myocardial Infarction

“…Ischemic stroke was defined as a neurologic deficit of sudden onset that persisted for more than 24 hours, corresponded to a vascular territory in the absence of primary hemorrhage, was not explained by other causes (e.g., trauma, infection, or vasculitis), and was corroborated by an imaging study when possible [18].…”

Atrial fibrillation in myocardial infarction patients: Impact on health care utilization

“…21 In addition, the risk of future stroke or transient ischemic attack during 1 year of follow-up was more than 3-fold greater in MI patients with transient AF occurring during the hospitalization for MI compared to those without AF in two different studies enrolling consecutive hospitalized patients. 22, 23 However, in another convenience sample of MI patients, while the incidence of ischemic stroke was much higher in the first year of follow-up in patients with AF than those without AF during hospitalization for MI, the odds of developing ischemic stroke over a mean of 7 years was no different between those with and without AF. 24 …”

Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States

“…In those with AF, the sample was limited to patients with nontransient and nonvalvular AF as both transient and valvular AF are associated with different levels of stroke risk, and thus, treatment approaches vary. 21,22 Patients were considered to have valvular AF if they had a diagnosis for a heart valve replacement or mitral valve stenosis (ICD-9-CM codes 42.2, 394.x, 396.1, 396.2, 396.8, or 746.5) or a procedure for a valve replacement (current procedural terminology codes 33405, 33420, 33422, 33425 to 33427, 33430, or 33496; ICD-9 procedure codes 35.0x, 35.1x, or 35.2x). Patients were considered to have transient AF if AF appeared within 12 months after hyperthyroidism (ICD-9-CM code 242.x) or within 30 days after coronary The American Journal of Cardiology (www.ajconline.org) The primary outcome of interest was direct medical costs (in 2014 USD).…”