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

Abstract

Atrial fibrillation (AF) is an independent predictor of mortality after acute myocardial infarction (AMI). We analyzed the relationship between biomarkers linked to myocardial stretch [NT-pro-brain natriuretic peptide (NT-proBNP)], myocardial damage [Troponin-T (TnT)] and inflammation [high-sensitivity C-reactive protein (hsCRP)] and new-onset AF during AMI to identify patients at high risk for AF. In a prospective multicenter registry of AMI patients from (TRIUMPH), we measured NT-proBNP, TnT, and hsCRP in patients without a history of AF (N=2370). New-onset AF was defined as AF that occurred during the index hospitalization. Hierarchical multivariable logistic regression models were used to determine the association of biomarkers with new-onset AF, after adjusting for other covariates. New-onset AF was documented in 114 AMI patients (4.8%; mean age 58 years; 32% women). For each 2-fold increase in NT-proBNP, there was an 18% increase in the rate of AF (OR 1.18 95% CI 1.03-1.35; p<0.02). Similarly, for every 2-fold increase in hs-CRP, there was a 15% increase in the rate of AF (OR 1.15 95% CI 1.02-1.30; p=0.02). TnT was not independently associated with new-onset AF (OR 0.96 95% CI 0.85-1.07; p=0.3). NT-proBNP and hs-CRP were independently associated with new in-hospital AF after MI, in both men and women, irrespective of race. Our study suggests that markers of myocardial stretch and inflammation, but not the amount of myocardial necrosis, are important determinants of AF in the setting of AMI.

Serial N-Terminal Pro Brain Natriuretic Peptide Assessments in Predicting New-Onset Atrial Fibrillation in ST Elevation Myocardial Infarction Patients who Undergo Primary Percutaneous Coronary Intervention

“…In accordance with previous studies in the healthy population [26] and in STEMI patients, [9] age has a strong association with the development of new-onset AF. Of note, previous studies did not report an association between HScTnT and AF [9]. Although incident AF was not associated with HScTnT in univariate analysis in our present analysis, AF >24 hours after admission was significantly associated with HScTnT plasma level.…”

“…Incident AF is associated with a higher rate of death, re-infarction, cardiogenic shock and ventricular arrhythmias, and therefore, identification of potentially high risk patients is important [5,6]. In accordance with previous studies in the healthy population [26] and in STEMI patients, [9] age has a strong association with the development of new-onset AF. Of note, previous studies did not report an association between HScTnT and AF [9].…”

“…Therefore, predicting AF in STEMI patients can impact clinical practice by identifying patients at increased risk after STEMI. Several biomarkers have been associated with new-onset AF, [8,9] A recent study showed that incident AF after STEMI can be predicted by N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level assessment [9]. However, in this study, NT-proBNP was assessed somewhere during the first 72 hours after admission and thus there are no data on the temporal relationship between serial NT-proBNP plasma level assessments and mode of onset AF in STEMI patients.…”

“…The association between NT-proBNP and AF has been previously reported in the general population [14] and previous studies have reported an association between NT-proBNP and incident AF [9,15]. Presumably, the increased LV diastolic pressure that results in an increase of NT-proBNP plasma level also results in an increased atrial stretch, inflammation and myocardial ischemia, which play a key role in the development of AF [16,17].…”

Atrial Fibrillation in Patients after Myocardial Infarction: Association with Changes in Heart Structure, Heart Failure and Age

“…З одного боку, ФП неґатив-но впливає на гемодинаміку, незалежно від її почат-кового стану, з іншого -СН є одним із основних етіо-лоґічних чинників ФП. Переважна більшість досліджень стосується гострого ІМ або раннього постінфарктного періоду [3,4,10]. Інформації щодо поширеності та предикторів ФП у віддалений період після ІМ недостатньо.…”