Clinical outcomes of atrial fibrillation and acute myocardial infarction in long-term follow up

    Authors

    Keywords

    atrial fibrillation, myocardial infarction, acute coronary syndrome

    DOI

    https://doi.org/10.15836/ccar2022.155

    Full Text

    **Introduction**: Atrial fibrillation (AF) and acute myocardial infarction (MI) often coexist together, whether it is MI in patients with earlier AF or AF as a complication of MI. Previously published work has shown results indicating worse quality of life in patients with both AF and MI, with some potential differences in long-term outcomes depending on time of fibrillation onset. (1, 2) We aimed to compare clinical outcomes of IM patients with prior and new onset AF at two tertiary centers. **Patients and Methods**: We evaluated 1662 patients discharged after acute MI at Dubrava University Hospital and „Merkur“ University Hospital from January 2017 to December 2021, followed up to present date. Among them, 28 patients who were discharged had AF prior to MI, whereas 42 patients had newly diagnosed AF. We compared the differences in baseline characteristics, all cause death as the primary outcome and all-combined MACE events as secondary outcome in follow up between patients without AF, prior AF and new onset AF. **Results**: Our results show that patients with AF diagnosed after MI were significantly older and were discharged with lower eGFR and left ventricular ejection fraction compared to the other groups (p<0.05). After comparing the groups in follow up, the new onset AF group had significantly lower survival time (HR 3.24 compared to no AF, HR 4.71 compared to prior AF, p<0.001). However, in multivariate analysis after adjustment for clinically relevant parameters, there was no significant difference in survival probability between the groups. There was no statistically significant difference in free-from MACE time between the three groups. **Conclusion**: Our data suggests potentially increased long-term mortality in those who develop AF in the acute setting of MI. Further research is necessary to evaluate the potential risks of new onset AF and to develop strategies for its prevention.

    Literature

    1. Carnicelli AP, Owen R, Pocock SJ, Brieger DB, Yasuda S, Nicolau JC, et al. Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction. Open Heart. 2021 December;8(2):e001726. https://doi.org/10.1136/openhrt-2021-001726
    2. Tseng CH, Chung WJ, Li CY, Tsai TH, Lee CH, Hsueh SK, et al. Statins reduce new-onset atrial fibrillation after acute myocardial infarction: A nationwide study. Medicine (Baltimore). 2020 January;99(2):e18517. https://doi.org/10.1097/MD.0000000000018517
    Cardiologia Croatica
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    Clinical outcomes of atrial fibrillation and acute myocardial infarction in long-term follow up

    Extended Abstract
    Issue9-10
    Published
    Pages155
    PDF via DOIhttps://doi.org/10.15836/ccar2022.155
    atrial fibrillation
    myocardial infarction
    acute coronary syndrome

    Authors

    Petra Bistrović*ORCIDDubrava University Hospital, Zagreb, Croatia
    Ivan SkorićORCIDUniversity of Zagreb, Zagreb, Croatia
    Irzal HadžibegovićORCIDDubrava University Hospital, Zagreb, Croatia
    Tomislav ŠipićORCIDDubrava University Hospital, Zagreb, Croatia
    Šime ManolaORCIDDubrava University Hospital, Zagreb, Croatia
    Ivana JurinORCIDDubrava University Hospital, Zagreb, Croatia

    *Correspondence email: pbistrovic@gmail.com

    Full Text

    Introduction: Atrial fibrillation (AF) and acute myocardial infarction (MI) often coexist together, whether it is MI in patients with earlier AF or AF as a complication of MI. Previously published work has shown results indicating worse quality of life in patients with both AF and MI, with some potential differences in long-term outcomes depending on time of fibrillation onset. (1, 2) We aimed to compare clinical outcomes of IM patients with prior and new onset AF at two tertiary centers.

    Patients and Methods: We evaluated 1662 patients discharged after acute MI at Dubrava University Hospital and „Merkur“ University Hospital from January 2017 to December 2021, followed up to present date. Among them, 28 patients who were discharged had AF prior to MI, whereas 42 patients had newly diagnosed AF. We compared the differences in baseline characteristics, all cause death as the primary outcome and all-combined MACE events as secondary outcome in follow up between patients without AF, prior AF and new onset AF.

    Results: Our results show that patients with AF diagnosed after MI were significantly older and were discharged with lower eGFR and left ventricular ejection fraction compared to the other groups (p<0.05). After comparing the groups in follow up, the new onset AF group had significantly lower survival time (HR 3.24 compared to no AF, HR 4.71 compared to prior AF, p<0.001). However, in multivariate analysis after adjustment for clinically relevant parameters, there was no significant difference in survival probability between the groups. There was no statistically significant difference in free-from MACE time between the three groups.

    Conclusion: Our data suggests potentially increased long-term mortality in those who develop AF in the acute setting of MI. Further research is necessary to evaluate the potential risks of new onset AF and to develop strategies for its prevention.

    Literature

    1. 1.
      Carnicelli AP, Owen R, Pocock SJ, Brieger DB, Yasuda S, Nicolau JC, et al. Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction. Open Heart. 2021 December;8(2):e001726.DOI
    2. 2.
      Tseng CH, Chung WJ, Li CY, Tsai TH, Lee CH, Hsueh SK, et al. Statins reduce new-onset atrial fibrillation after acute myocardial infarction: A nationwide study. Medicine (Baltimore). 2020 January;99(2):e18517.DOI