Chronic kidney disease predicts atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

Abstract

Background: Atrial fibrillation (AF) often complicates ST-segment elevation myocardial infarction (STEMI). Predictors of AF in this setting include factors related to the acute phase of STEMI and pre-existing conditions. More recently, novel AF predictors have been identified in the general population. We aimed to assess the ability of such novel factors to predict STEMI-related AF.Methods: Data were collected from STEMI patients treated by primary PCI. Factors related to the acute phase of STEMI (Killip class, heart rate, blood pressure on admission, post-PCI TIMI flow), classic (age, hypertension, heart failure, previous myocardial infarction), and more novel (body mass index [BMI], diabetes, chronic kidney disease [CKD], chronic obstructive pulmonary disease [COPD]) AF predictors were evaluated. The ability of these novel factors to predict STEMI-related AF was assessed.Results: Of the 629 studied patients, 10.5% presented STEMI-related AF. AF patients had higher Killip class on admission (p < .0001) and lower post-PCI TIMI flow (p < .01), they were older (p < .0001) and more likely to have a history of heart failure (p = .02) and myocardial infarction (p = .04). BMI, history of diabetes and COPD were similar between patients with and without AF (all p > .05), but CKD was more common in AF patients (p < .0001). In multiple regression analysis, CKD remained a strong independent predictor of STEMI-related AF (p < .0001).Conclusion: Irrespective of other factors, CKD was associated with increased risk of STEMI-related AF. CKD could be used to identify patients who will develop AF in this setting and who would benefit from closer follow-up and more intensive prophylactic strategies.

Keywords: Atrial fibrillation; ST-segment elevation myocardial infarction; chronic kidney disease; prediction; primary percutaneous coronary intervention.