The influence of clinical and medical history factors and anti-thrombotic therapy on the prognosis in patients with atrial fibrillation and myocardial infarction

Abstract

Aim: To assess an impact of clinical and medical history factors and antithrombotic therapy on the prognosis in patients with non-valvular atrial fibrillation (AF) admitted to the cardiology in-patient clinic for myocardial infarction (MI).
 Materials and methods: This was a retro-prospective study. Two hundred and fifty six (256) patients with AF plus MI (median age 71.0 [65.0; 79.3] years; men, 143 (55.8%)) were included into the retrospective part of the study in 20182019. Data on their clinical and medical history particulars, as well as on antithrombotic therapy were collected from their medical files. Nineteen (19) [13; 25] months after the index event (MI), telephone contact was made with patients or their relatives in order to assess the patient's life status, as well as record the frequency of non-fatal MI and cerebral strokes (MI). Contact was established with 253 patients. The completeness of the sample coverage is 99.0%.
 Results: During the follow-up after discharge from the hospital, 29.6% (n = 75) of patients died, 40.7% (n = 103) of patients reached the composite endpoint (CЕ), which included deaths, non-fatal MI and brain strokes.
 The patients who died, compared to those who survived, were older (77.0 [62.0; 82.0] vs 68.0 [62.0;76.7] years, respectively, p 0.001), with a smaller proportion of men (44.0% vs 61.2%, respectively, p = 0.012). They were also more likely to have had type 2 diabetes mellitus (50.7% vs 37.1%, p = 0.04) and the history of acute stroke (24.0% vs 8.4%, p 0.001), and less likely to have had percutaneous coronary intervention (48.0% vs 64.0%, p 0.001). Serum creatinine levels in those who have died were higher than in the surviving patients (114.0 [95.0; 139.0] mmol/l vs 99.5 [85.0; 120.0] mmol/l, p 0.001).
 The patients who have achieved CE, compared to those who have not, were older (75.0 [67.0; 81.0] vs 65.0 [50.0; 82.0] years, respectively, p 0.001), with a smaller proportion of men (48.5% vs 61.3%, respectively, p = 0.045), higher proportion of patients with past history of stroke (20.4% vs 8.0%, p = 0.005) and fewer patients who had underwent percutaneous coronary intervention (52.4% vs 66.0%, p 0.03).
 There was no significant association between the administration of anti-platelet agents and/or oral anticoagulants and outcomes in the patients with AF and MI.
 Conclusion: In the patients with AF and MI, a higher death risk and achievement of CE were significantly associated with age and a history of stroke. The use of anti-platelet agents and oral anticoagulants in various combinations had no significant impact on the outcomes in this patient group, which is likely related to small duration of the follow-up and small patient sample.

Changes in Antithrombotic Therapy Prescription in Patients with a Combination of Atrial Fibrillation and Myocardial Infarction in a Specialised Inpatient Department from 2016–2019 and Associations with Prognosis

“…A total of 360 patients with MI and AF were included in the research: in 2016–2017, 104, and 2018–2019, 256 patients. We described these groups of patients in detail in a previously published paper [ 13 , 14 ]. We analyzed patients on the CHA 2 DS 2 -VASc scales (congestive heart failure, hypertension, age 75 and older, diabetes mellitus, stroke or transient ischemic attack, vascular diseases, age 65 to 74 years, women) and HAS-BLED (hypertension, impaired kidney/liver function, stroke, bleeding anamnesis or predisposition, labile international normalized ratio, old age, simultaneous drug/alcohol use) points [ 15 , 16 ].…”

“…In this study, we analyzed patient mortality and the combined endpoint (CEP), which includes fatal outcomes after the index event, non-fatal MI and CS, and fatal and non-fatal MI and CS separately. The prospective part of this work, analyzing the vital status of patients and the frequency of registration of MI and CS in patients hospitalized in 2018–2019, was described in a previously published article [ 14 ].…”