Significance of Atrial Fibrillation Complicating ST-Segment Elevation Myocardial Infarction

Podolecki, Tomasz; Lenarczyk, Radosław; Kowalczyk, Jacek; Jędrzejczyk-Patej, Ewa; Świątkowski, Andrzej Marian; Chodór, Piotr; Sedkowska, Agnieszka; Streb, Witold; Mitręga, Katarzyna; Kalarus, Zbigniew

doi:10.1016/j.amjcard.2017.05.017

Cited by 15 publications

(13 citation statements)

References 23 publications

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“…4 One study reported that late-AF, in particular, has worse long-term prognosis compared with early paroxysmal atrial fibrillation (PAF). 7 A higher risk for stroke was also reported for patients with transient AF complicating acute inferior myocardial infarction (MI), despite treatment with antiplatelet therapy. 8…”

Section: Introductionmentioning

confidence: 99%

Early Atrial Fibrillation During Acute Myocardial Infarction May Not Be an Indication for Long-Term Anticoagulation

et al. 2020

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Patients with new-onset of atrial fibrillation (NOAF) during acute myocardial infarction (AMI) currently receive long-term oral anticoagulation. The risk for stroke of “early” versus “late” onset of atrial fibrillation (AF) has not been elucidated. Consecutively, AMI patients admitted to a tertiary medical center were analyzed. We excluded patients with preexisting AF, AMI onset ≥24 hours prior to admission, significant valvular disease, fever >38.5°C, in-hospital death, or coronary artery bypass graft. Atrial fibrillation was verified by electrocardiography and medical records. Overall 7061 patients were included, 1.4% developed “early-paroxysmal AF (PAF)” that resolved within 24 hours of admission and 2.5% had “late-AF” beyond the first 24 hours. Median follow-up was ≈6 years. Primary end points included ischemic stroke and all-cause mortality. Stroke rates were higher only in patients with late-AF versus no-AF but not in the early-PAF: 10.6% versus 4.2%, 5.3%, respectively ( P < .001). Death rates were higher in patients with late-AF and early-PAF versus no-AF: 55.3%, 43.2%, and 29.2%, respectively ( P < .001). Congestive heart failure, hypertension, age ≥75, diabetes mellitus, a stroke or transient ischemic attack, vascular disease, age 65-74, female (CHA2DS2-VASc) score underestimated stroke risk in the late-AF group. In conclusion, the study generates the hypothesis that patients with early-PAF may not have a high stroke risk questioning the indication for long-term anticoagulation.

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Section: Introductionmentioning

confidence: 99%

Early Atrial Fibrillation During Acute Myocardial Infarction May Not Be an Indication for Long-Term Anticoagulation

et al. 2020

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“…Hwang [25] NA 22.7 versus 9.5%, HR 2.51 (95%CI 1.68~3.76), P < 0.001 Karabağ [26] NA 24.1% vs 7%, p = 0.015 Topaz [27] 6.4% vs. 2.1%, p = 0.08. 17% vs. 9.1%, p = 0.07 Podolecki [28] 7.6%-27.4% vs 4.2%-6.3%, p < 0.05 12%-38.7% vs 9%-12.9%, p < 0.05 Rencuzogullari [29] NA 23.3% vs. 11%; p = 0.032 Rhyou [30] NA NA Romanov [31] 0.0% 0.0% Mazzone [32] NA HR 2.885 (95% CI 1.146-7.268), P = 0.025 Modin [33] NA NA . Although there was no report of short-term outcomes, the Kaplan-Meier survival curve showed an early separation in outcomes rates between patients with and without AF, with poor outcomes in the patients with AF [19].…”

Section: Namentioning

confidence: 96%

New-Onset Atrial Fibrillation in the Post-Primary PCI Setting: A Systematic Review

AL-Obaidi

Al-Kinani

Al-Ali

et al. 2019

Acta Medica Bulgarica

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Background: Atrial fibrillation is a relatively common complication of acute myocardial infarction with significant impact on the short and long-term prognosis. Methods: A systematic literature review was done through Pubmed and CENTRAL to extract data related to new-onset atrial fibrillation following primary PCI. Results: Searching resulted in twenty-one matched studies. Extraction of data showed an incidence rate of new-onset atrial fibrillation (2.8%-58%). A negative impact was found on the outcomes of patients treated with primary PCI with increased short and long-term mortality and morbidity. Conclusion: New-onset atrial fibrillation is an adverse prognostic marker in patients with acute myocardial infarction treated invasively. Preventive measures and anticoagulant therapy should be considered more intensively in this subset of patients.

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“…Based on recently published data, the incidence of new-onset AF among ACS events varied from 4.5%-10.9% in clinical settings of ACS. [1][2][3][4][5] Regardless of whether AF was newly developed or pre-existent, it was associated with over a twofold increased risk of mortality. 1-4 6 However, it remains unclear whether new-onset paroxysmal AF (PaAF), which was transient during the admission, is related to long-term adverse events, including mortality, and particularly, stroke in this population.…”

Section: Introductionmentioning

confidence: 99%

New-onset paroxysmal atrial fibrillation in acute myocardial infarction: increased risk of stroke

et al. 2020

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ObjectiveTo investigate the long-term prognostic implications of transient new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI).DesignRetrospective observational study.SettingSingle tertiary centre.ParticipantsThis study included 2523 patients who presented with AMI from 3 June 2003 to 24 February 2015, after the exclusion of those with prior AF or in-hospital death.Outcome measuresPatients were divided into three groups according to the occurrence and type of new-onset AF: (1) sinus rhythm (SR) group; (2) paroxysmal AF (PaAF: AF converted to SR prior to discharge) group and (3) persistent AF (PeAF: AF persisted during the hospitalisation) group. Post-discharge all-cause mortality and stroke incidences were compared between the groups.ResultsNew-onset AF was observed in 271 patients (10.7%; PaAF: 230, PeAF: 41). The median follow-up period was 7.2 years (IQR: 5.2–9.4). The incidence of all-cause death and stroke was highest in the PeAF group, followed by the PaAF and SR groups (all-cause mortality: 48.8% vs 26.5% vs 14.7%, p<0.001; stroke 22.0% vs 8.3% vs 4.4%, p<0.001). In the multivariable analysis, PaAF and PeAF were associated with an increased risk of stroke (PaAF, HR: 1.972, 95% CI: 1.162–3.346; PeAF, HR: 5.160, CI: 2.242–11.873) compared with SR. The PaAF group showed a higher incidence of post-discharge AF than the SR group (29.1% vs 4.2%, p<0.001).ConclusionsNew-onset AF following AMI is associated with poor long-term outcomes. Even when AF episodes are brief and are converted to SR, new-onset AF remains associated with an increased risk of recurrent AF and stroke.

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Significance of Atrial Fibrillation Complicating ST-Segment Elevation Myocardial Infarction

Cited by 15 publications

References 23 publications

Early Atrial Fibrillation During Acute Myocardial Infarction May Not Be an Indication for Long-Term Anticoagulation

Early Atrial Fibrillation During Acute Myocardial Infarction May Not Be an Indication for Long-Term Anticoagulation

New-Onset Atrial Fibrillation in the Post-Primary PCI Setting: A Systematic Review

New-onset paroxysmal atrial fibrillation in acute myocardial infarction: increased risk of stroke

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