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Multicenter Study
. 2019 Nov;113(5):948-957.
doi: 10.5935/abc.20190190.

New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And Mortality

[Article in English, Portuguese]
Kisa Hyde Congo  1 , Adriana Belo  2 , João Carvalho  1 , David Neves  1 , Rui Guerreiro  1 , João António Pais  1 , Diogo Brás  1 , Mafalda Carrington  1 , Bruno Piçarra  1 , Ana Rita Santos  1 , José Aguiar  1
Affiliations
Multicenter Study

New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And Mortality

[Article in English, Portuguese]
Kisa Hyde Congo et al. Arq Bras Cardiol. 2019 Nov.

Abstract

Backgrund: New-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge, with prognostic significance.

Objective: To study the incidence, impact on therapy and mortality, and to identify predictors of development of new-onset atrial fibrillation during hospital stay for ST-segment elevation myocardial infarction.

Methods: We studied all patients with ST-elevation myocardial infarction included consecutively, between 2010 and 2017, in a Portuguese national registry and compared two groups: 1 - no atrial fibrillation and 2 - new-onset atrial fibrillation. We adjusted a logistic regression model data analysis to assess the impact of new-onset atrial fibrillation on in-hospital mortality and to identify independent predictors of its development. A p value < 0.05 was considered significant.

Results: We studied 6325 patients, and new-onset atrial fibrillation was found in 365 (5.8%). Reperfusion was successfully accomplished in both groups with no difference regarding type of reperfusion. In group 2, therapy with beta-blockers and angiotensin-conversion enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) was less frequent, 20.6% received anticoagulation at discharge and 16.1% were on triple therapy. New-onset atrial fibrillation was associated with more in-hospital complications and mortality. However, it was not found as an independent predictor of in-hospital mortality. We identified age, prior stroke, inferior myocardial infarction and complete atrioventricular block as independent predictors of new-onset atrial fibrillation.

Conclusion: New-onset atrial fibrillation remains a frequent complication of myocardial infarction and is associated with higher rate of complications and in-hospital mortality. Age, prior stroke, inferior myocardial infarction and complete atrioventricular block were independent predictors of new onset atrial fibrillation. Only 36.7% of the patients received anticoagulation at discharge.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Flowchart with patients included and excluded.
Figure 2
Figure 2
Reperfusion therapy. AF: atrial fibrillation; PCI: percutaneous coronary intervention.
Figure 3
Figure 3
Kaplan-Meier survival curves for the two groups.
See this image and copyright information in PMC

Comment in

References

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