Acute Myocardial Infarction Complicated by Atrial Fibrillation in the Elderly

Rathore, Saif S.; Berger, Alan K.; Weinfurt, Kevin P.; Schulman, Kevin A.; Oetgen, William J.; Gersh, Bernard J.; Solomon, Allen J.

doi:10.1161/01.cir.101.9.969

Cited by 304 publications

(231 citation statements)

References 23 publications

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“…1 -4 The most important underlying mechanism producing the new-onset AF is hemodynamic disturbance imposed by AMI. 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.…”

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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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: 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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“…AF is an important comorbidity in ACS. Most recent studies have demonstrated that AF is associated with a higher risk of subsequent cardiovascular events33 and mortality12 in ACS. Thus, both ECG variables (ie, QTc prolongation) and AF are predictors of adverse outcomes in patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

Low Homoarginine Levels in the Prognosis of Patients With Acute Chest Pain

Atzler

Baum

Ojeda

et al. 2016

JAHA

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BackgroundThe endogenous amino acid homoarginine predicts mortality in cerebro‐ and cardiovascular disease. The objective was to explore whether homoarginine is associated with atrial fibrillation (AF) and outcome in patients with acute chest pain.Methods and ResultsOne thousand six hundred forty‐nine patients with acute chest pain were consecutively enrolled in this study, of whom 589 were diagnosed acute coronary syndrome (ACS). On admission, plasma concentrations of homoarginine as well as brain natriuretic peptide (BNP), and high‐sensitivity assayed troponin I (hsTnI) were determined along with electrocardiography (ECG) variables. During a median follow‐up of 183 days, 60 major adverse cardiovascular events (MACEs; 3.8%), including all‐cause death, myocardial infarction, or stroke, were registered in the overall study population and 43 MACEs (7.5%) in the ACS subgroup. Adjusted multivariable Cox regression analyses revealed that an increase of 1 SD of plasma log‐transformed homoarginine (0.37) was associated with a hazard reduction of 26% (hazard ratio [HR], 0.74; 95% CI, 0.57–0.96) for incident MACE and likewise of 35% (HR, 0.65; 95% CI, 0.49–0.88) in ACS patients. In Kaplan–Meier survival curves, homoarginine was predictive for patients with high‐sensitivity assayed troponin I (hsTnI) above 27 ng/L (P<0.05). Last, homoarginine was inversely associated with QTc duration (P<0.001) and prevalent AF (OR, 0.83; 95% CI, 0.71–0.95).ConclusionLow plasma homoarginine was identified as a risk marker for incident MACEs in patients with acute chest pain, in particular, in those with elevated hsTnI. Impaired homoarginine was associated with prevalent AF. Further studies are needed to investigate the link to AF and evaluate homoarginine as a therapeutic option for these patients.

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“…23 The prevalence of AF in AMI ranges from 2% to 21%, 23 and this arrhythmia not only increases in-hospital mortality 24,25 but also worsens long-term outcome after discharge. 24 In turn, the accurate data on the prevalence of AF in an unselected population of patients with stable CAD are not available.…”

Section: -20mentioning

confidence: 99%

Atrial fibrillation in outpatients with stable coronary artery disease : results from the multicenter RECENT study

Zielonka¹,

Tkaczyszyn²,

Mende³

et al. 2015

Polish Archives of Internal Medicine

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Acute Myocardial Infarction Complicated by Atrial Fibrillation in the Elderly

Abstract: Background-Although atrial fibrillation (AF) is a common complication of acute myocardial infarction (MI), patient characteristics and association with outcomes remain poorly defined in the elderly.

Cited by 304 publications

References 23 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

Low Homoarginine Levels in the Prognosis of Patients With Acute Chest Pain

Atrial fibrillation in outpatients with stable coronary artery disease : results from the multicenter RECENT study

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