Atrial Fibrillation and Mortality in Patients with Acute Myocardial Infarction: A Systematic Overview and Meta-analysis

Abstract

Atrial fibrillation (AF) confers an increased risk of mortality in patients hospitalized for acute myocardial infarction (AMI). However, it is unclear whether new-onset and preexisting AF portend a different risk. We extracted data from studies that evaluated in-hospital mortality in patients with AMI and included information on cardiac rhythm. Overall, the risk of mortality was higher in patients with AF than in those in sinus rhythm (OR 2.00, 95 % CI: 1.93-2.08; P < 0.0001). Compared with patients who remained in sinus rhythm, the risk of death was increased in patients with new AF certain (sinus rhythm on admission, new AF during hospitalization, and history of no evidence of prior AF; OR 3.38, 95 % CI: 2.98-3.83; P < 0.0001), new AF uncertain (sinus rhythm on admission, AF during hospitalization, but no clear information about previous history of AF; OR 1.90, 95 % CI:1.83-1.98; P < 0.0001), and permanent AF (AF before and during hospitalization; OR 2.01, 95 % CI:1.70-2.38;P < 0.0001). In a meta-regression analysis, the risk of death was 87 % higher in patients with new AF certain than in those with permanent AF (P = 0.013) or AF uncertain (P = 0.003), and not dissimilar in patients with new AF uncertain and permanent AF (P = 0.706).

Long-term mortality of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation for acute and stable coronary artery disease

“…However, controversy exists whether AF carries a different mortality risk in ACS versus stable CAD [11,12,[19][20][21].…”

“…Second, non-fatal bleeding, occurring at an annual rate between 3% and over 15% in the spectrum of warfarin monotherapy, dual antiplatelet therapy, their combinations and TT, have been shown to affect late mortality [23]. Perhaps most importantly, cardiovascular risk factors and co-morbidities, measured and unmeasured, may contribute to worse prognosis [2,5,11,19,24,25].…”

Management and Outcomes in Acute Coronary Syndrome With Atrial Fibrillation in “Non-Invasive” Clinic

“…Так, например, данные международного регистра GRACE показывают, что у пациентов с ОКС как с предсуществующей, так и с вновь возникшей ФП значительно выше госпитальная летальность (14,5% и 8,9%, соответственно), чем у пациентов без ФП (1,2%) [2]. Результаты мета-анализа исследований с ОКС показали, что риск госпитальной смерти у пациентов с ФП на ЭКГ был в 2 раза выше, чем у пациентов с синусовым ритмом (относительный риск 2,00; 95% доверительный интервал 1,93-2,08; р<0,0001) [3].…”

“…the independent predictors of death after discharge from hospital up to 12 months from ACs onset were the baseline hemoglobin <110 g/L (oR 16,00; 95% Ci 2,57-99,50; р=0,003), non-treatment by antithrombotics before ACs (oR 7,22; 95% Ci 2,20-23,68; р=0,001), hospital risk by GRACe >140 pts. (oR 6,88; 95% Ci 1,44-32,80; р=0,015) and non-prescription of aspirin in discharge (oR 3,21; 95% Ci 1,61; р=0,02). Conclusion.…”

Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis

“…Few published studies have been conducted regarding this question and the results are conflicting. 2,5---11 In a recent meta-analysis, Angeli et al 12 showed that AF in the setting of AMI was associated with a two-fold higher risk of in-hospital mortality, but the risk of death was 87% higher in patients with new-onset AF than in those with permanent AF.…”