Predictors and outcomes of new-onset atrial fibrillation in patients with acute myocardial infarction

Abstract

Background/Aim. The onset of atrial fibrillation (AF) in the acute phase of myocardial infarction (MI) may be a predictor of poor prognosis. The aim of our study was to examine this relationship. Methods. Six hundred patients were enrolled in the study and divided into two groups. The first group included 48 patients with new-onset AF and the second group of 552 patients without this arrhythmia. Patients with previously registered AF were excluded from the study. We investigated the correlation between new-onset AF and intra-hospital mortality as well as mortality during the follow-up period of 48 months. We also analyzed predictors of this arrhythmia. Results. Newonset AF was registered in 48 (8%) patients. The independent predictors of this arrhythmia were older age, particularly more than 70 years [odds ratio 2.37; 95% confidence interval (CI) 1.23-4.58) and increased body mass index (odds ratio 1.17; 95% CI 1.04-1.33). Patients with new-onset AF had a higher mortality during the hospital course than patients without AF, but this difference was not statistically significant (10.4% vs 5.6%, p = 0.179). Patients with this arrhythmia had also a higher mortality after follow-up period of 48 months than patients without AF (33.3 % vs 17.8%, p = 0.009). Major adverse cardiac and cardiovascular events (MACCE) defined as death, recurrent MI, revascularization, and stroke were more after registered in patients with new-onset AF than in those with no this arrhythmia after follow-up period of 48 months (52.1% vs 33.9%, p = 0.011). However, multivariate Cox's regression analysis demonstrated that new-onset AF was not an independent predictor of mortality during the follow-up period of 48 months (HR 0.68; 95% CI 0.38-1.20; p = 0.182). Conclusion. New-onset AF in patients with MI was associated with a higher mortality as well as MACCE after the follow-up period of 48 months but was not an independent predictor of mortality during this period.

Heart Disease and Relaxin: New Actions for an Old Hormone

“…Macrostructural disarray within the cardiac muscle due to fibrotic infiltration and disruptions of ionic currents and conductance at a cellular level predispose the infarcted heart to increased arrhythmic activity[36]. The incidence of atrial fibrillation (AF), one of the most prevalent arrhythmias encountered clinically, is estimated to be between 6–21% after MI[37], and is correlated with a higher mortality and adverse events during and after in-hospital period. Inflammatory mediators such as C-reactive protein (CRP), IL-6, and TNFα are elevated in AF, lending credence to I/R-associated inflammation as a possible etiology[38].…”

Trends in the Incidence and In-Hospital Outcomes of Patients With Atrial Fibrillation Complicated by Non-ST-Segment Elevation Myocardial Infarction

“…1,2 Acute myocardial infarction (AMI) is a known risk factor for AF 3,4 and is an independent predictor of mortality in patients with AF. 5,6 Conversely, AF is an independent predictor of AMI, specifically non-ST-segment elevation myocardial infarction (NSTEMI). 7 –9 Patients presenting with acute symptoms of AF, especially those with rapid ventricular response, may develop troponin elevations, which occur in 8% to 20% of patients with acute-onset AF.…”

Incidence of Atrial Fibrillation in Acute St-Elevation Myocardial Infarction

“…In our study we observed that incidence of new onset of AF in MI patients is also associated with age, with passage of time risk of this incidence also increases. In a study conducted by Vukmirović M et al16 reported 6% incidence of AF after AMI and also reported that new onset of AF is associated with age. Arrhythmias are common in older age.…”