Abstract
Study Population and Design: Acute Atrial Fibrillation (AF) is an important complication of ST Segment Elevation Myocardial Infarction (STEMI) even in the Primary angioplasty era. AF is an independent predictor of both short termand long term mortality. What is the incremental risk of developing complications when AF complicates STEMI?
Materials and Methods: It was a single center, prospective cohort study, conducted from October 2014 to January 2016. The patients were divided into three groups. 1. Those with AF at admission. 2. Those developing AF within 24 hours of admission. 3. Those developing AF after 24 hours and till discharge. The patient’s clinical and echocardiographic profile were documented. They were followed up for development of heart failure, arrhythmias, cardiogenic shock, Cerebrovascular Accident (CVA) and death.
Results: A total of 118 STEMI patients (59 with AF and 59 without) were included in the study. In-hospital (20.3% vs. 6.8% p= 0.031) and total mortality was significantly higher in AF Group (23.7% vs. 10.2%, p=0.040). 1 and 3 month mortality were not significantly different in AF and non AF groups. The in-hospital MACCE rate was higher in the AF group. The 1 and 3 month MACCE were not significantly different. Pericarditis was more common in patients who had AF.(20.3% vs. 6.8%,p= 0.03). Acute Kidney Injury was more in AF group.(16.9 % vs. 5.1%, p=0.04). Age>/=70, systemic hypertension, Left Ventricular EF<40%, Left Atrial dilatation, ischemic mitral regurgitation >/=grade2 were significant predictors of AF on univariate analysis. Hypertension was the only independent predictor of AF in multivariate analysis.
Keywords: Atrial Fibrillation, ST Elevation Myocardial Infarction, Myocardial infarction complications.
References
1. Eldar M, Canetti M, Rotstein Z, et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation 1998;97:965–970.
2. 2.Crenshaw BS, Ward SR, Granger CB, Stebbins AL,et al. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.J Am CollCardiol 1997;30:406–413.
3. Rathore SS, Berger AK, Weinfurt KP, Schulman KA,etal.Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 2000;101:969–974
4. Wong CK, White HD, Wilcox RG,et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J 2000;140:878–885.
5. Crenshaw BS, Ward SR, Granger CB et al. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries J Am CollCardiol1997, vol.30 (pg.406 413
6. Kinjo K, Sato H, Sato H, Ohnishi Y, Hishida E, Nakatani D. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol 2003;92:1150–1154.
7. Mehta RH, Dabbous OH, Granger CB, et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. Am J Cardiol. 2003;92:1031–6.
8. Consuegra-Sanchez L, Melgarejo-Moreno A, Galcera-Tomas J,et al. Short- and long-term prognosis of previous and new-onsetatrial fibrillation in ST-segment elevation acute myocardial infarction.Rev EspCardiol. 2015;68:31–8.
9. Podolecki T, Lenarczyk R, Kowalczyk J, et al. Effect of type ofatrial fibrillation on prognosis in acute myocardial infarction treated invasively. Am J Cardiol. 2012;109:1689–93.
10. Lehto M, Snapinn S, Dickstein K, et al. Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience. Eur Heart J. 2005; 26:350–6.
11. Sakata K, Kurihara H, Iwamori K, et al. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction. Am J Cardiol.1997; 80:15227.
12. Helmers C, Lundman T, Mogensen L, Orinius E, Sjogren A, Wester PO. Atrial fibrillation in acute myocardial infarction. Acta Med Scand 1973; 193: 39–44.
13. Cristal N, Szwarcberg J, Gueron M. Supraventricular arrhythmias in acute myocardial infarction: Prognostic importance of clinical setting; mechanism of production. Ann Intern Med 1975; 82: 35–9.
14. Hunt D, Sloman G, Penington C. Effect of atrial fibrillation on prognosis of acute myocardial infarction. Br Heart J 1978; 40: 303–7.
15. Sugiura T, Iwasaka T, Ogawa A et al. Atrial fibrillation imyocardial infarction. Am JCardiol.1997; 80:15227.
16. Pizzetti F, Turazza FM, Franzosi MG, et al. GISSI-3 Investigators. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart. 2001;86:527–32.
17. Lopes RD, Elliott LE, White HD, et al. Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention: results from the APEX-AMI trial. Eur Heart J. 2009;30:2019–28.
18. Toshiro Tomomatsu, ItsuroMorishima, TakahitoSone, New Onset At rial Fibrillation, But Not Pre-existing The Arrhythmia, May Be An Independent Predictor Of Cardiac Mortality In Patients With Acute Myocardial Infarction; JACC March 12, 2013 Volume 61, Issue 10
19. Kinjo K, Sato H, Sato H, et al. Osaka Acute Coronary Insufficiency Study (OACIS) Group. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol. 2003;92:1150–4.
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.139
