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

Abstract

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.

New-Onset Atrial Fibrillation After Acute Myocardial Infarction and Its Relation to Admission Biomarkers (from the TRIUMPH Registry)

“…Although several, but not all, prior studies demonstrated independent associations of CRP with AF in several clinical contexts, 22-24 including AMI 25,26 , these prior studies did not take into account the level of NT-proBNP or TnT in their analyses. The independent association with hsCRP in our markers of myocardial stretch and necrosis are taken into account.…”

Peak troponin I level predicts new-onset atrial fibrillation in patients with myocardial infarction

“…The relationship between markers of myocardial injury and AF events was also evaluated in the literature and multivariate models were created to clarify whether primary myocardial damage per se or associated left ventricular dysfunction was an independent predictor of AF occurrence. Results of a multicenter registry of nonselective myocardial infarction patients suggested that the markers of myocardial stretch (brain natriuretic peptide) and inflammation (CRP), but not the amount of myocardial necrosis (troponin), were found to be important determinants of AF in the setting of myocardial infarction [13]. When STEMI patients admitted for PCI were investigated for the drivers of new-onset AF, a temporal association between troponin plasma levels and the development of AF was reported [14].…”

Evaluation of Anticoagulation Practice With New-Onset Atrial Fibrillation in Patients with Sepsis and Septic Shock in Medical Intensive Care Unit: A Retrospective Observational Cohort Study

“…Sepsis is characterized as a hyper-inflammatory condition involving the release of pro-inflammatory cytokines and interleukins. The induction of sepsis-induced atrial fibrillation (AF) has been attributed to the generation of an anatomical and electrophysiological substrate from severe inflammation [ 4 , 5 ]. Sepsis is a hyper-inflammatory state that leads to depressed myocardial function.…”