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Observational Study
. 2016 Apr 15;117(8):1213-8.
doi: 10.1016/j.amjcard.2016.01.012. Epub 2016 Jan 28.

Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission

Amartya Kundu  1 , Kevin O'Day  1 , Amir Y Shaikh  1 , Darleen M Lessard  2 , Jane S Saczynski  3 , Jorge Yarzebski  2 , Chad E Darling  4 , Ramses Thabet  5 , Mohammed W Akhter  6 , Kevin C Floyd  6 , Robert J Goldberg  2 , David D McManus  7
Affiliations
Observational Study

Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission

Amartya Kundu et al. Am J Cardiol. .

Abstract

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and contributes to high rates of in-hospital adverse events. However, there are few contemporary studies examining rates of AF in the contemporary era of AMI or the impact of new-onset AF on key in-hospital and postdischarge outcomes. We examined trends in AF in 6,384 residents of Worcester, Massachusetts, who were hospitalized with confirmed AMI during 7 biennial periods between 1999 and 2011. Multivariate logistic regression analysis was used to examine associations between occurrence of AF and various in-hospital and postdischarge complications. The overall incidence of AF complicating AMI was 10.8%. Rates of new-onset AF increased from 1999 to 2003 (9.8% to 13.2%), and decreased thereafter. In multivariable adjusted models, patients developing new-onset AF after AMI were at a higher risk for in-hospital stroke (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.6 to 4.1), heart failure (OR 2.0, 95% CI 1.7 to 2.4), cardiogenic shock (OR 3.7, 95% CI 2.8 to 4.9), and death (OR 2.3, 95% CI 1.9 to 3.0) than patients without AF. Development of AF during hospitalization for AMI was associated with higher rates of readmission within 30 days after discharge (21.7% vs 16.0%), but no significant difference was noted in early postdischarge 30-day all-cause mortality rates (8.3% vs 5.1%). In conclusion, new-onset AF after AMI is strongly related to in-hospital complications of AMI and higher short-term readmission rates.

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Figures

Figure 1
Figure 1
Trends in the Incidence Rates of Atrial Fibrillation in Patients Hospitalized with Acute Myocardial Infarction AF= Atrial Fibrillation
Figure 2
Figure 2
Adjusted Odds of Developing In-Hospital Complications Among Patients with Acute Myocardial Infarction and New-Onset Atrial Fibrillation as Compared to No Atrial Fibrillation (with accompanying 95% Confidence Intervals)
Figure 3
Figure 3
Trends in Hospital Case-Fatality Rates in Patients who Developed Atrial Fibrillation during Hospitalization for an Acute Myocardial Infarction
See this image and copyright information in PMC

References

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