New-onset Atrial Fibrillation in Patients Presenting with Acute Myocardial Infarction

Abstract

Background Atrial fibrillation (AF) can be seen secondary to the complications after acute myocardial infarction (AMI), but it has a poor prognosis when occurs independently. These patients are prone to an increased risk of all in-hospital major cardiac complications and also at an increased risk of mortality. Therefore, it is important to quantify the burden of this aggravating complication in an otherwise lethal manifestation of acute coronary syndrome. The aim of this study was to find the frequency of AF in patients presenting with AMI and the factors associated with it. Methods We conducted this observational study on 216 patients who presented with AMI at the largest cardiac center of Karachi, Pakistan from July 2014 to January 2015 with AMI without a past history of AF. Patients underwent routine clinical assessment and laboratory investigations. Atrial fibrillation, detected on electrocardiographic assessment at the time of admission or during hospital stay without a prior history of persistent atrial flutter or paroxysmal atrial fibrillation, was classified as new-onset atrial fibrillation (AF). Results We selected a total of 216 patients, 117 (54.2%) male and mean age of 50.76 ± 6.00 years. Diabetes was found in 140 (64.8%), 164 (75.9%) were hypertensive, and 61 (28.2%) patients were smokers. ST-segment elevation myocardial infarction (STEMI) was diagnosed in 97 (44.9%) patients. The new onset of atrial fibrillation was found in 27 (12.5%) of the patients with AMI. Univariate analysis revealed a statistically significant association of new-onset AF with hypertension. Conclusion The new onset of atrial fibrillation was found in 12.5% of the patients presented with acute myocardial infarction. It is a significant complication in term of its frequency in AMI and it is more common in hypertensive patients.

MR-proANP level predicts new onset atrial fibrillation in patients with acute myocardial infarction

“…In addition, our findings do not suggest any relationship between new-onset AF in AMI patients and hypertension, diabetes and obesity, as also noted previously by Vukmirovic et al (2017) and Rhyou et al (2018). However a study of 216 patients with myocardial infarction found hypertension to be a predicting factor of AF (p ¼ 0.002) (Iqbal et al 2019), while another found AMI patients who developed AF to be more likely to demonstrate hypertension (p ¼ 0.033) (Parashar et al 2013). In addition, the development of new-onset AF was found to be predicted by hypertension in a GRACE registry of ACS (Mehta et al 2003) and PURSUIT trial (Al-Khatib et al 2001).…”

Comprehensive Use of Routine Clinical Parameters to Identify Patients at Risk of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

“…Annoura et al reported the "cholesterol paradox" in AF patients and found lower serum cholesterol levels and triglycerides in patients with paroxysmal AF [46]. Another study [25] showed that low serum levels of LDL-C and high-density lipoprotein cholesterol (HDL-C) were present in patients with AF, irrespective of the type of AF. Watanabe et al [47] demonstrated that a low HDL-C level was strongly associated with an increased risk of developing AF, and the total cholesterol and LDL-C levels were contrarily associated with AF.…”

“…Most previous studies usually prioritized only one clinical parameter [7][8][9][10][11][12][13][14][15] or considered only patients with one type of AMI, mostly ST-Elevation Myocardial Infarction (STEMI) [9,[16][17][18][19][20]. Some studies were based on international registers [21][22][23][24], which, beyond the obvious advantages, included data from different clinical centers, sometimes from different countries, which could implicate different diagnostic methods and different treatment possibilities [11,25]; most of them were performed in the earlier years, based upon the previous guidelines of AMI treatment. Our study aimed to check whether the comprehensive use of the routinely checked clinical parameters could help to identify patients with a high probability of NOAF based on current, consecutive AMI patients hospitalized and treated according to the current guidelines in one large clinical center.…”

Prevalence of First Diagnosed Atrial Fibrillation in Patients Admitted with Acute Coronary Syndrome and with Impaired Renal Function with and without Diabetes Mellitus

“…Increase in the risk factors of AF such as age more than 55 years, hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), CKD, CAD, and OSA is directly associated with increase in the burden of AF. Patients with multiple risk factors have >2.5 folds chance for the development of AF as compared with no risk factor or less than 2 risk factors [11][12][13][14]. The mean age of patient who experience AF without looking at their type of AF is around 66 years in developed country while in developing country it is >50 years and it is more common is women than men [15].…”