The Prognostic Value of Atrial Fibrillation on 30-Day Clinical Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Lin, Cheng-Jei; Liu, Chu-Feng; Kung, Chia-Te; Sun, Cheuk‐Kwan; Lin, Yu‐Chun; Leu, Steve; Chua, Sarah; Yeh, Kuo-Ho; Wu, Chiung‐Jen; Chen, Yung‐Lung; Yip, Hon‐Kan

doi:10.1536/ihj.52.153

Cited by 22 publications

(21 citation statements)

References 29 publications

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“…37) AF occurs in 6 to 11% of STEMI patients, and has been associated with increased in-hospital and long-term morality. [38][39][40][41] Recently, Batra, et al published a paper on the importance of AF in AMI patients, including STEMI and NSTEMI. 42) They found that irrespective of AF type, for example, new onset, paroxysmal, or chronic AF, AF patients suffered a higher rate of MACE compared to NSR, and there was no difference in the MACE rate between the types of AF.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients

et al. 2017

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SummaryThe prognostic significance of atrial fibrillation (AF) on mortality in ST-segment elevation myocardial infarction (STEMI) patients is not clearly understood. To elucidate the clinical significance of AF on mortality for 1 year in STEMI patients, we retrospectively analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) database, which spans January 2008 to September 2010 and includes 14,329 patients with acute myocardial infarction. We selected 5,556 patients with marked ECG rhythm (NSR, normal sinus rhythm or AF) on emergency room arrival, < 12 hours of symptom onset, and who underwent primary percutaneous coronary intervention (PCI) within 90 minutes of arriving at the hospital. Patients who had been followed-up for at least for 1 year were analyzed (2,636 of NSR, 119 of AF). At enrollment, AF patients were older (70.7 versus 65.5 years, P < 0.001) and had lower systolic blood pressure (120.6 versus 125.9 mmHg, P = 0.050), a higher heart rate (80.4 versus 75.6/minute, P = 0.009), and a higher rate of Killip III, IV (25.0 versus 14.2%, P = 0.002). Patients with AF showed clearly higher all-cause mortality (22.7 versus 9.5%, HR 2.51, 95%CI 1.68~3.76, P < 0.001) and cardiac death rate (17.7 versus 7.5%, HR 2.49, 95%CI 1.59~3.90, P < 0.001) at 1 year after admission compared patients with NSR. AF induced significantly higher all-cause mortality and cardiac mortality rate in STEMI patients who were appropriately revascularized with primary PCI compared to NSR at 1 year. (Int Heart J 2017; 58: 486-494) Key words: Major adverse cardiac event, Target lesion revascularization, Normal sinus rhythm T he general prevalence of atrial fibrillation (AF) in developed countries is approximately 1.5~2%, and the average age of AF patients is continuously rising and is now between 75 and 85 years old.1,2) This arrhythmia is directly associated with a 5-fold risk of stroke, a 3-fold incidence of congestive heart failure (CHF), and higher mortality.3) The prevalence of AF is higher in diverse medical comorbid conditions such as hypertension, thyrotoxicosis, CHF, ischemic heart disease, left ventricular hypertrophy, and valvular heart diseases. In HF particularly, the prevalence of AF has been reported to range from 15 to 50% depending on age and the duration of underlying medical or cardiologic abnormalities. [4][5][6] Lifelong or temporal oral anticoagulation was needed by 5~7% of patients who underwent percutaneous coronary intervention (PCI) with a stent, and most of them were patients with AF. 7) AF patients undergoing PCI usually have more major adverse cardiac events compared to patients with normal sinus rhythm (NSR).8) The ARIAM registry showed higher inhospital mortality in new onset AF compared to NSR or previously existing AF in acute coronary syndrome (ACS), 9) and new onset AF was one of the important predictors of mortality, and non-coronary artery bypass graft (CABG) related major bleeding in ST-segment elevation myocardial infarction (STE-MI) underwent primary PCI in HORIZON-AMI study.10) The Denmark...

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients

et al. 2017

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“…Some studies have reported the baseline characteristics and clinical outcomes of AF patients who underwent PCI [4][5][6][7][8]. However, there are few studies that relate to the second-generation DES era.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports revealed that 5-11 % of patients who undergo percutaneous coronary intervention (PCI) have concomitant AF [4][5][6]. AF has been associated with poorer in-hospital and long-term outcomes in patients with coronary artery disease (CAD) who underwent PCI in the bare-metal stent and first-generation drug-eluting stent (DES) eras, owing to their high risk of ischemic events [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Comparison of mid-term outcomes between patients with and without atrial fibrillation undergoing coronary stenting in the second-generation drug-eluting stent era: from the SHINANO registry

Miura

Miyashita

Motoki

et al. 2016

Cardiovasc Interv and Ther

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Little is known about the mid-term outcomes of patients with atrial fibrillation (AF) who undergo coronary stenting in the second-generation drug-eluting stent (DES) era. We evaluated the 1-year outcomes of AF patients undergoing percutaneous coronary intervention (PCI) with second-generation DES. This retrospective cohort analysis used integrated data from the SHINANO registry, a prospective observational multicenter cohort study, which enrolled 1923 consecutive patients undergoing PCI for any coronary artery disease. We retrospectively recruited 917 of these patients (mean age, 71.3 ± 10.0 years; male, 77 %) who received PCI with 2nd generation DES. The primary endpoint was net adverse clinical events (NACE: cardiac death, stroke, MI, stent thrombosis, and major bleeding) at 1 year. The secondary endpoints were major adverse cardiovascular events (MACE: cardiac death, stroke, and MI), stroke, MI, and major bleeding at 1 year. One-year follow-up was completed in 871 (94.9 %) patients, of whom 85 had AF. The incidence of NACE (15.4 vs. 7.3 %, P = 0.008), MACE (10.6 vs. 5.4 %, P = 0.047), and major bleeding (6.0 vs. 2.3 %, P = 0.049) were all significantly higher in AF compared to non-AF patients. On multivariate analysis, AF was an independent predictor of NACE (HR 2.32, 95 % CI 1.24-4.34, P = 0.008). In the second-generation DES era, patients with AF undergoing PCI still have a poorer prognosis, with more thrombotic and bleeding events, than those without AF. More attention should be paid to the thrombotic and bleeding risk in AF patients undergoing PCI.

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“…In another recent prospective cohort study by Lin et al . [14] the AF population was frequently represented by females with history of diabetes, HT and stroke, extensive myocardial damage, higher Killip class (>3)and NYHA class, and low EF. Similarly, less of these patients had adequate postprocedural coronary perfusion flow rate (TIMI 3 flow rates 84.7% vs.93.7%, for AF and sinus rhythm groups, p=0.003).…”

Section: Incidence and Clinical Characteristics Of Af In Ami (Table 1)mentioning

confidence: 99%

“…In patients undergoing primary PCI, AF was not found to be an independent determinant of inpatient mortality, but remained a significant predictor of 30-day mortality [14, 16], 90-day outcomes [15] and 1-year mortality [4]. This could be partly attributable to the fact that better TIMI-3 flow rates were achieved using PCI and adjunct antithrombotic therapy, and the use of contemporary treatment with ACEIs [9,34], ARBs [11, 12], beta-blockers [36] and statins [37, 38] all of which have been shown to reduce the risk of AF development especially in patients with higher Killip, NYHA class and LV dysfunction.…”

Section: Prognostic Significance Of Af In Ami (Table 2)mentioning

confidence: 99%

Atrial Fibrillation in Acute St-Elevation Myocardial Infarction: Clinical and Prognostic Features

Görenek¹,

Kudaiberdieva²

2012

CCR

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The Prognostic Value of Atrial Fibrillation on 30-Day Clinical Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Cited by 22 publications

References 29 publications

Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients

Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients

Comparison of mid-term outcomes between patients with and without atrial fibrillation undergoing coronary stenting in the second-generation drug-eluting stent era: from the SHINANO registry

Atrial Fibrillation in Acute St-Elevation Myocardial Infarction: Clinical and Prognostic Features

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