Key result
New-onset atrial fibrillation occurred in 5.8% of STEMI patients and was associated with more in-hospital complications and mortality, though not an independent predictor of in-hospital mortality.
Why the study?
New-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge with prognostic significance, warranting investigation into its incidence, predictors, and impact on therapy and mortality during STEMI hospitalization.
Does new-onset atrial fibrillation during hospital stay for STEMI impact in-hospital mortality and therapy?
Observational (n=6,325)
Yes
Does new-onset atrial fibrillation during hospital stay for STEMI impact in-hospital mortality and therapy?
New-onset atrial fibrillation complicates 5.8% of STEMI cases and is associated with higher in-hospital mortality and complications, yet only a minority receive anticoagulation at discharge.
New-onset AF signals higher in-hospital risk in STEMI without independent mortality prediction; leaves open optimal management strategies pending prospective trials.
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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Congo et al. (2019) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=6,325). New-onset atrial fibrillation vs. No atrial fibrillation was evaluated on In-hospital mortality. New-onset atrial fibrillation occurred in 5.8% of STEMI patients and was associated with more in-hospital complications and mortality, though not an independent predictor of in-hospital mortality.
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