Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Dec;8(2):e001726.
doi: 10.1136/openhrt-2021-001726.

Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Anthony P Carnicelli  1 , Ruth Owen  2 , Stuart J Pocock  3 , David B Brieger  4 , Satoshi Yasuda  5 , Jose Carlos Nicolau  6 , Shaun G Goodman  7 , Mauricio G Cohen  8 , Tabassome Simon  9   10 , Dirk Westermann  11   12 , Katarina Hedman  13 , Karolina Andersson Sundell  13 , Christopher B Granger  14
Affiliations
Observational Study

Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Anthony P Carnicelli et al. Open Heart. 2021 Dec.

Abstract

Objective: Atrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF.

Methods/results: The prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1-3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06-1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality.

Conclusions: In stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF.

Trial registration number: ClinicalTrials: NCT01866904.

Keywords: atrial fibrillation; health services; myocardial infarction; stroke.

PubMed Disclaimer

Conflict of interest statement

Competing interests: APC reports grant funding from the National Institutes of Health. RO has received research grant support from AstraZeneca. SJP has received research grant support from AstraZeneca. DBB has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Eli Lilly, Merck and Sanofi. SY has received speaker/consulting honoraria and/or research grant support from Takeda, Daiichi Sankyo, AstraZeneca, Boehringer Ingelheim and BMS. JCN has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, GSK, Merck, Novartis, Pfizer and Sanofi. SGG has received research grant support (eg, steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (eg, advisory boards) from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, GlaxoSmithKline, HLS Therapeutics, Janssen/Johnson & Johnson, Merck, Novartis, Novo Nordisk A/C, Pendopharm, Pfizer, Regeneron, Sanofi, Servier and Valeo Pharma, and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating Center for Clinical Research, Duke Clinical Research Institute, New York University Clinical Coordinating Center and PERFUSE Research Institute. MGC has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Medtronic, Abiomed and Merit Medical. TS has received speaker/consulting honoraria and/or research grant support from Astellas, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer and Sanofi. DW has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Berlin-Chemie, Biotronik and Novartis. KH and KAS are employees of AstraZeneca. CBG has received consulting honoraria and/or research grant support from Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Eli Lilly, Gilead, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Medtronic, Pfizer, Salix Pharmaceuticals, Sanofi, Takeda and The Medicines Company.

Figures

Figure 1
Figure 1
Baseline factors independently associated with oral anticoagulant use at enrolment in patients with a history of atrial fibrillation (n=702).
Figure 2
Figure 2
Adjusted associations between history of atrial fibrillation and self-reported QoL at baseline. QoL, quality of life; VAS, visual analogue scale. Estimated using ordinal logistic regression models for index score, VAS score and each individual domain. OR >1 means that patients with a history of atrial fibrillation (AF) have poorer self-rated health than those with no history of AF. For instance, the adjusted common OR for VAS score is 1.17, which means that patients with a history of AF have 17% increased odds of being below any cut-off value (<90, <80, <70 or <60) for the EQ-5D VAS score compared with patients with no history of AF. Adjusted for factors associated with baseline EQ-5D index score (sex, age, body mass index, heart rate, smoking status, years of education, diabetes, history of stroke, angina, peripheral vascular disease, peptic ulcer disease, chronic obstructive pulmonary disease, heart failure, anaemia, emergency department visit within the preceding 6 months, type of index myocardial infarction, diuretic use and geographical region).
Figure 3
Figure 3
In patients without history of atrial fibrillation at enrolment (n=7575), baseline factors independently associated with development of incident atrial fibrillation after registry enrolment. ED, emergency department; EQ-5D, EuroQoL five dimensions questionnaire.
Figure 4
Figure 4
Cumulative incidence of (A) all-cause mortality, (B) bleeding requiring hospitalisation, (C) primary composite outcome and (D) secondary composite outcome in patients with a history of atrial fibrillation at enrolment. Primary composite outcome: all-cause mortality, MI, stroke, unstable angina requiring urgent revascularisation. Secondary composite outcome: cardiovascular mortality, MI, stroke AF, atrial fibrillation. MI, myocardial infarction.
Figure 5
Figure 5
Occurrence of (A) all-cause hospitalisation (p<0.001), (B) cardiovascular hospitalisation (p<0.001) and (C) bleeding requiring hospitalisation (p=0.007) during follow-up by history of atrial fibrillation at enrolment. The p value was calculated to compare patients with no history of AF and patients with a history of AF. AF, atrial fibrillation.
See this image and copyright information in PMC

References

    1. Saczynski JS, McManus D, Zhou Z, et al. . Trends in atrial fibrillation complicating acute myocardial infarction. Am J Cardiol 2009;104:169–74. 10.1016/j.amjcard.2009.03.011 - DOI - PMC - PubMed
    1. Lopes RD, Li L, Granger CB, et al. . Atrial fibrillation and acute myocardial infarction: antithrombotic therapy and outcomes. Am J Med 2012;125:897–905. 10.1016/j.amjmed.2012.04.006 - DOI - PubMed
    1. Zeymer U, Annemans L, Danchin N, et al. . Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry. Eur Heart J Acute Cardiovasc Care 2019;8:121–9. 10.1177/2048872618769057 - DOI - PubMed
    1. Lin HJ, Wolf PA, Benjamin EJ, et al. . Newly diagnosed atrial fibrillation and acute stroke. The Framingham Study. Stroke 1995;26:1527–30. 10.1161/01.str.26.9.1527 - DOI - PubMed
    1. Hindricks G, Potpara T, Dagres N, et al. . 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021;42:373–498. 10.1093/eurheartj/ehaa612 - DOI - PubMed

Publication types

MeSH terms

Associated data