Does early or late newly diagnosed atrial fibrillation worsen 2-year outcomes in patients with acute myocardial infarction undergoing PCI?
In patients with AMI undergoing PCI, both early and late newly diagnosed atrial fibrillation are associated with increased 2-year risks of heart failure hospitalization and major bleeding, with ischemic occlusion of atrial branches serving as a shared predictor.
Abstract Background Atrial fibrillation (AF) is a common arrhythmic complication in individuals presenting with acute myocardial infarction (AMI); however, the distinct clinical features of AF when it manifests at different stages—either early or late during hospitalization—remain insufficiently characterized. Objective This study aimed to investigate the clinical characteristics, 2-year outcomes, and predictive determinants of early versus late newly diagnosed atrial fibrillation (NDAF) in patients with AMI undergoing percutaneous coronary intervention (PCI). Methods A total of 2,345 consecutive AMI patients treated with PCI were retrospectively reviewed and stratified into three categories: early NDAF, late NDAF, and no NDAF. Comparative analyses were performed across these groups, including assessments of baseline clinical profiles, angiographic and echocardiographic findings, and 2-year clinical outcomes. Results Among the cohort, 195 patients (8.3%) developed NDAF during hospitalization, with early NDAF observed in 3.8% and late NDAF in 4.5%. Over the 2-year follow-up, patients with either early or late NDAF demonstrated significantly higher rates of hospitalization for heart failure and major bleeding compared to those without NDAF (P < 0.001). Multivariable logistic regression identified ischemic occlusion of atrial branches (P < 0.001) and left atrial enlargement (P = 0.015) as independent predictors of early NDAF. For late NDAF, ischemic occlusion of atrial branches (P = 0.025) and reduced left ventricular ejection fraction (LVEF ≤ 40%, P = 0.007) were significant predictors. Hospitalization due to heart failure was independently associated with LVEF ≤ 40% (P = 0.016), early NDAF (P = 0.039), and late NDAF (P < 0.001). Conclusions Both early and late NDAF were linked to increased risks of heart failure–related hospitalization and major bleeding compared to patients who remained in sinus rhythm. Importantly, ischemic occlusion of atrial branches emerged as a shared and independent predictor for both early and late NDAF following AMI.
Wu et al. (Thu,) studied this question.
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