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

Congo, Kisa Hyde; Belo, Adriana; Carvalho, João; Neves, David; Guerreiro, Rui; Pais, João António; Brás, Diogo; Carrington, Mafalda; Piçarra, Bruno; Santos, Ana Rita; Aguiar, José

doi:10.5935/abc.20190190

Acessibilidade / Reportar erro

Brasil

Arquivos Brasileiros de Cardiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arq. Bras. Cardiol. 113 (5) • Nov 2019 • https://doi.org/10.5935/abc.20190190 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Atrial Fibrillation; ST Elevation Myocardial Infarction/complications; Hospitalization; Mortality; Antihypertensive; Anticoagulants

N	All	Group 1 - No AF	Group 2 - New onset AF	p	OR (CI 95%)
N	6325	5960 (94.2%)	365 (5.8%)	p	OR (CI 95%)
Female (%)	24.2	23.6	34.2	< 0.001	1.69 (1.35-2.12)
Age (years) ≥ 75 (%)	63 ± 13	62 ± 13	71 ± 13	< 0.001	3.24 (2.61-4.01)
Age (years) ≥ 75 (%)	21.6	20.1	44.9	< 0.001	3.24 (2.61-4.01)
BMI >30 (%)	20.1	20.2	18.3	0.413	0.89 (0.67-1.18)
Arterial hypertension (%)	59.6	59.0	69.1	< 0.001	1.55 (1.23-1.95)
Diabetes mellitus (%)	23.7	23.4	28.8	0.021	1.32 (1.04-1.67)
Dyslipidemia (%)	51.1	51.4	47.7	0.186	0.86 (0.69-1.07)
Smoking habits (%)	38.6	39.3	28.6	< 0.001	0.55 (0.43-0.69)
Family history of coronary disease (%)	8.5	8.8	2.4	< 0.001	0.25 (0.12-0.53)
Prior MI (%)	10.1	10.1	9.9	0.881	0.97 (0.68-1.39)
Prior PCI (%)	8.5	8.7	5.8	0.051	0.64 (0.41-1.00)
Prior CABG (%)	1.0	0.9	2.5	0.011	2.71 (1.33-5.52)
Valvular heart disease (%)	0.9	0.7	3.4	< 0.001	4.61 (2.41-8.81)
History of heart failure (%)	1.4	1.3	3.6	< 0.001	2.81 (1.55-5.11)
Previous stroke (%)	5.4	5.0	10.4	< 0.001	2.19 (1.53-3.12)
Peripheral artery disease (%)	2.6	2.5	5.0	0.004	2.06(1.25-3.40)
Pacemaker/ ICD (%)	0.4	0.4	0.5	0.647	1.48 (0.35-6.32)
Chronic renal disease (%)	2.9	2.8	4.1	0.132	1.51 (0.88-2.59)
CPOD (%)	3.4	3.2	6.9	< 0.001	2.23 (1.45-3.43)
Dementia (%)	1.9	1.7	5.3	< 0.001	3.18 (1.92-5.27)

	All	No AF	New onset AF	p
AMI (%)
- Anterior	48.4	48.4	49.0	0.806
- Inferior	50.6	50.6	49.6	0.704
- LBBB	1.0	1.0	1.4	0.424
Heart rate (bpm) >100 bpm (%)	77 ± 19	77 ± 18	79 ± 24	0.066
Heart rate (bpm) >100 bpm (%)	11.7	11.3	18.7	< 0.001
Systolic arterial pressure (mmHg) < 100 mmHg (%)	135 ± 30	135 ± 30	126 ± 28	< 0.001
Systolic arterial pressure (mmHg) < 100 mmHg (%)	12.3	12.0	18.1	0.001
Diastolic arterial pressure (mmHg) < 60 mmHg (%)	80 ± 18	80 ± 18	76 ± 17	< 0.001
Diastolic arterial pressure (mmHg) < 60 mmHg (%)	14.6	14.4	17.5	0.102
Killip-Kimbal class ≥ 2 (%)	13.0	12.1	27.3	< 0.001
Creatinine (mg/dL) ≥ 2 mg/dL (%)	1 ± 0.8	1 ± 0.8	1.2 ± 0.9	< 0.001
Creatinine (mg/dL) ≥ 2 mg/dL (%)	3.6	3.3	8.5	< 0.001
Hemoglobin (g/dL) ≥12 g/dL (%)	14.1 ± 1.8	14.1 ± 1.8	13.5 ± 2	< 0.001
Hemoglobin (g/dL) ≥12 g/dL (%)	87.8	88.2	81.3	< 0.001

	All	Group 1 - No AF	Group 2 - New onset AF	p
Aspirin	98.6	98.6	99.2	0.349
Clopidogrel	86.7	86.6	89.3	0.138
Ticagrelor	17.6	17.9	12.3	0.042
Prasugrel	0	0	0
Other AP	5.4	5.5	5.2	0.859
GPIIbIIIa inhibitors	33.6	33.5	35.8	0.362
UFH	46.3	46.3	45.6	0.784
Fondaparinux	6.1	6.0	7.7	0.185
Bivalirudin	0.7	0.6	0.8	0.512
LMWH	45.1	44.3	58.2	< 0.001
Vitamin K antagonists	1.3	1.0	5.2	< 0.001
NOAC	0.3	0.3	0.8	0.106
Beta-blockers	79.6	80.2	69.5	< 0.001
ACE inhibitors/ARB	86.3	86.6	80.8	0.002
Aldosterone antagonists	13.5	12.6	27.3	< 0.001
Statins	94.6	94.5	95.6	0.364
Diuretics	25.1	23.0	58.5	< 0.001
Amiodarone	6.5	2.9	65.9	< 0.001
Other antiarrhythmic drugs	1.0	0.9	1.9	0.08
Digitalis	0.9	0.3	11.3	< 0.001
Inotropes	7.8	6.6	27.3	< 0.001
Levosimendan	1.0	0.7	5.5	< 0.001

	All	Group 1 - No AF	Group 2 - New onset AF	p
Aspirin	96.2	96.3	93.1	0.005
Clopidogrel	80.3	80.2	81.3	0.634
Ticagrelor	19.3	19.6	13.7	0.065
Prasugrel	0.3	0.3	0	1.000
Other AP	4.9	5.0	3.6	0.289
Vitamin K antagonists	2.4	1.9	11.2	< 0.001
NOACs	1.2	0.8	7.9	< 0.001
Beta-blockers	81.6	82.2	71.1	< 0.001
ACE inhibitors/ARB	87.7	88.0	81.3	< 0.001
Aldosterone antagonists	12.0	11.2	26.0	< 0.001
Diuretics	20.1	18.7	46.6	< 0.001
Amiodarone	2.4	1.1	26.4	< 0.001
Other antiarrhythmic drugs	0.1	0.1	0	1.000
Digitalis	0.4	0.2	4.0	< 0.001

Antithrombotic therapy	Group 2 - New onset AF
Aspirin + Clopidogrel + Vitamin K antagonists	10.2
Aspirin + Clopidogrel + NOACs	5.9
Aspirin + Ticagrelor/Prasugrel + Vitamin K antagonists	0
Aspirin + Ticagrelor/Prasugrel + NOACs	0
Total	16.1

	All	Group 1 - No AF	Group 2 - New onset AF	p
LV Ejection fraction < 50%	43.4	42.2	62.1	p < 0.001
Heart failure	16.8	14.9	48.5	p < 0.001
Cardiogenic shock	5.9	4.9	22.3	p < 0.001
Atrioventricular block	5.3	4.8	14.2	p < 0.001
Ventricular tachycardia	2.6	2.1	10.7	p < 0.001
Cardiac arrest	5.2	4.8	11.8	p < 0.001
Mechanical complications	1.3	1.2	3.3	p = 0.002
Stroke	0.7	0.6	2.5	p = 0.001
Major bleeding	1.9	1.6	6.8	p < 0.001

	OR (CI 95%)	p
Age	1.02 (1.01-1.04)	p < 0.001
Prior stroke	1.87 (1.09-3.21)	p = 0.023
Inferior located STEMI	1.57 (1.13-2.18)	p = 0.007
Complete AV block	1.94 (1.19-3.16)	p = 0.008

	All	Group 1 - No AF	Group 2 - New onset AF	p
Swan-Ganz catheter	0.6	0.4	3.6	p < 0.001
Intra-aortic balloon pump	1.2	1.1	2.7	p = 0.012
Invasive mechanical ventilation	3.5	3.2	9.0	p < 0.001
Transvenous cardiac pacing	3.6	3.1	11.2	p < 0.001

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Mailing Address: Kisa Hyde Congo, Hospital Espírito Santo de Évora - Largo Senhor da Pobreza, s/n Évora 7000-811 - Portugal. E-mail: kisacongo@gmail.com, kisahydecongo@gmail.com