Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients

Abstract

SummaryThe prognostic significance of atrial fibrillation (AF) on mortality in ST-segment elevation myocardial infarction (STEMI) patients is not clearly understood. To elucidate the clinical significance of AF on mortality for 1 year in STEMI patients, we retrospectively analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) database, which spans January 2008 to September 2010 and includes 14,329 patients with acute myocardial infarction. We selected 5,556 patients with marked ECG rhythm (NSR, normal sinus rhythm or AF) on emergency room arrival, < 12 hours of symptom onset, and who underwent primary percutaneous coronary intervention (PCI) within 90 minutes of arriving at the hospital. Patients who had been followed-up for at least for 1 year were analyzed (2,636 of NSR, 119 of AF). At enrollment, AF patients were older (70.7 versus 65.5 years, P < 0.001) and had lower systolic blood pressure (120.6 versus 125.9 mmHg, P = 0.050), a higher heart rate (80.4 versus 75.6/minute, P = 0.009), and a higher rate of Killip III, IV (25.0 versus 14.2%, P = 0.002). Patients with AF showed clearly higher all-cause mortality (22.7 versus 9.5%, HR 2.51, 95%CI 1.68~3.76, P < 0.001) and cardiac death rate (17.7 versus 7.5%, HR 2.49, 95%CI 1.59~3.90, P < 0.001) at 1 year after admission compared patients with NSR. AF induced significantly higher all-cause mortality and cardiac mortality rate in STEMI patients who were appropriately revascularized with primary PCI compared to NSR at 1 year. (Int Heart J 2017; 58: 486-494) Key words: Major adverse cardiac event, Target lesion revascularization, Normal sinus rhythm T he general prevalence of atrial fibrillation (AF) in developed countries is approximately 1.5~2%, and the average age of AF patients is continuously rising and is now between 75 and 85 years old.1,2) This arrhythmia is directly associated with a 5-fold risk of stroke, a 3-fold incidence of congestive heart failure (CHF), and higher mortality.3) The prevalence of AF is higher in diverse medical comorbid conditions such as hypertension, thyrotoxicosis, CHF, ischemic heart disease, left ventricular hypertrophy, and valvular heart diseases. In HF particularly, the prevalence of AF has been reported to range from 15 to 50% depending on age and the duration of underlying medical or cardiologic abnormalities. [4][5][6] Lifelong or temporal oral anticoagulation was needed by 5~7% of patients who underwent percutaneous coronary intervention (PCI) with a stent, and most of them were patients with AF. 7) AF patients undergoing PCI usually have more major adverse cardiac events compared to patients with normal sinus rhythm (NSR).8) The ARIAM registry showed higher inhospital mortality in new onset AF compared to NSR or previously existing AF in acute coronary syndrome (ACS), 9) and new onset AF was one of the important predictors of mortality, and non-coronary artery bypass graft (CABG) related major bleeding in ST-segment elevation myocardial infarction (STE-MI) underwent primary PCI in HORIZON-AMI study.10) The Denmark...

Risk Scoring System for Prognosis Estimation of Multivessel Disease Among Patients with ST-Segment Elevation Myocardial Infarction

“…The data in the study were from KAMIR from November 2005 to January 2008, and the Korean Working Group on Myocardial Infarction Registry (KORMI) from February 2008 to June 2012. [12][13][14] These databases were designed to identify characteristics of Korean AMI patients, and to determine better treatment options to improve patient survival. The cohort was comprised of STEMI patients who underwent percutaneous coronary intervention (PCI) after hospital arrival.…”

Fisetin Alleviates Atrial Inflammation, Remodeling, and Vulnerability to Atrial Fibrillation after Myocardial Infarction

“…A trial fibrillation (AF) is increasingly recognized as a major global health burden and is obviously associated with the risk of embolic stroke, heart failure, and overall mortality. 1,2) AF can present as a complication in acute myocardial infarction (AMI); AF in AMI patients can further deteriorate cardiac function and coronary perfusion. 3) The relationship between MI and AF has been described as "AF, a risk marker or a causal mediator of death after MI."…”

Role of Novel Oral Anticoagulant for Patient with Atrial Fibrillation Underwent Percutaneous Coronary Intervention

“…There were no significant differences in the composite cardiovascular outcome between AF subtypes, AF showed significantly higher incidence of all-cause mortality (HR, 1.19; 95% CI, 1.41-1.80), MI (HR, 1.14; 95% CI, 1.05-1.24), and ischemic stroke (HR, 2.29; 95% CI, 1.92-2.74). 17) Hwang et al 4) had analyzed the clinical impact of AF in the patients with appropriately treated with PPCI within 12 hours after chest pain onset with Korean AMI Registry from January 2008 to September 2009. Total 2,755 patients were included, patients with documented AF in emergency room were 119 (4.3%), patients with AF were older (70.7±13.6 years vs. 65.5±12.7 years, p<0.001), lower systolic blood pressure on arrival (120.6±30.2 mmHg vs. 125.9±28.0 mmHg, p=0.05), higher N-terminal (NT)-pro hormone BNP (proBNP) level (2,465.0±5,547.1 mg/dL vs. 1,579.8±4,301.3 mg/dL, p=0.049), strong tendency of lower left ventricular ejection fraction (49.6±13.7% vs. 52.3±14.2 mmHg, p=0.057).…”

“…AF was one of independent predicting factors including lower systolic blood pressure, faster heart rate, higher creatinine, higher classes of Killip, higher level of NT-proBNP for all-cause mortality in this high risk population. 4) And, according to the report of Rogacka et al 18) adding DAPT after PCI with bare metal stent (BMS) or DES on long-term use of OAC developed 4.7% of major bleeding complications for mean clinical follow-up duration of 21.0±19.8 months and 67% of major bleeding event occurred in the first month after DAPT initiation. So, AF is clear and definite risk factor for MACE including all-cause mortality even in appropriately treated with timely-fashioned proton pump inhibitor in STEMI patients, and prescription rate of OAC was unreasonably low universally.…”