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Meta-Analysis
. 2017 Sep;24(14):1555-1566.
doi: 10.1177/2047487317715769. Epub 2017 Jun 15.

Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: A systematic review and meta-analysis

Vidar Ruddox  1 , Irene Sandven  2 , John Munkhaugen  3 , Julie Skattebu  1 , Thor Edvardsen  4 , Jan Erik Otterstad  1
Affiliations
Meta-Analysis

Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: A systematic review and meta-analysis

Vidar Ruddox et al. Eur J Prev Cardiol. 2017 Sep.

Abstract

Background In contemporary atrial fibrillation trials most deaths are cardiac related, whereas stroke and bleeding represent only a small subset of deaths. We aimed to evaluate the long-term risk of cardiac events and all-cause mortality in individuals with atrial fibrillation compared to no atrial fibrillation. Design A systematic review and meta-analysis of studies published between 1 January 2006 and 21 October 2016. Methods Four databases were searched. Studies had follow-up of at least 500 stable patients for either cardiac endpoints or all-cause mortality for 12 months or longer. Publication bias was evaluated and random effects models were used to synthesise the results. Heterogeneity between studies was examined by subgroup and meta-regression analyses. Results A total of 15 cohort studies was included. Analyses indicated that atrial fibrillation was associated with an increased risk of myocardial infarction (relative risk (RR) 1.54, 95% confidence interval (CI) 1.26-1.85), all-cause mortality (RR 1.95, 95% CI 1.50-2.54) and heart failure (RR 4.62, 95% CI 3.13-6.83). Coronary heart disease at baseline was associated with a reduced risk of myocardial infarction and explained 57% of the heterogeneity. A prospective cohort design accounted for 25% of all-cause mortality heterogeneity. Due to there being fewer than 10 studies, sources of heterogeneity were inconclusive for heart failure. Conclusions Atrial fibrillation seems to be associated with an increased risk of subsequent myocardial infarction in patients without coronary heart disease and an increased risk of, all-cause mortality and heart failure in patients with and without coronary heart disease.

Keywords: Atrial fibrillation; heart failure; mortality; myocardial infarction.

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Figures

Figure 1.
Figure 1.
Forest plots for the risk of: (a) myocardial infarction; (b) all-cause mortality; and (c) heart failure associated with atrial fibrillation. ES (95% CI): risk ratio (95% confidence interval).
Figure 1.
Figure 1.
Forest plots for the risk of: (a) myocardial infarction; (b) all-cause mortality; and (c) heart failure associated with atrial fibrillation. ES (95% CI): risk ratio (95% confidence interval).
Figure 1.
Figure 1.
Forest plots for the risk of: (a) myocardial infarction; (b) all-cause mortality; and (c) heart failure associated with atrial fibrillation. ES (95% CI): risk ratio (95% confidence interval).
See this image and copyright information in PMC

References

    1. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO). Eur Heart J 2016; 37: 2893–2962. - PubMed
    1. EHRA Scientific Committee Task Force, Gorenek B, Pelliccia A, et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace: European pacing, arrhythmias, and cardiac electrophysiology: Journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2017; 19: 190–225. DOI: 10.1093/europace/euw242. - PMC - PubMed
    1. Vermond RA, Van Gelder IC, Crijns HJ, et al. Does myocardial infarction beget atrial fibrillation and atrial fibrillation beget myocardial infarction? Circulation 2015; 131: 1824–1826. - PubMed
    1. Gomez-Outes A, Lagunar-Ruiz J, Terleira-Fernandez AI, et al. Causes of death in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol 2016; 68: 2508–2521. - PubMed
    1. Soliman EZ, Lopez F, O’Neal WT, et al. Atrial fibrillation and risk of ST-segment elevation versus non-ST-segment elevation myocardial infarction: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2015; 131: 1843–1850. - PMC - PubMed

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