Key result
Declining GFR linked to up to ~3-fold higher incidence of new-onset AF during AMI.
Why the study?
Atrial fibrillation frequently complicates AMI and worsens prognosis, but whether AF is associated with glomerular filtration rate in AMI had never been investigated.
Does a reduced glomerular filtration rate increase the incidence of new-onset atrial fibrillation and mortality in patients with acute myocardial infarction?
Observational (n=2,445)
No
Does a reduced glomerular filtration rate increase the incidence of new-onset atrial fibrillation and mortality in patients with acute myocardial infarction?
p-value: p=<0.0001
A reduced glomerular filtration rate at admission is strongly associated with an increased incidence of new-onset atrial fibrillation and higher mortality in patients presenting with acute myocardial infarction.
Reduced GFR was associated with higher new-onset AF in AMI; leaves open whether renal function modifies AF prevention or monitoring strategies.
Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated. Methods: We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 (n = 1887): GFR >60; group 2 (n = 492): GFR 60–30; group 3 (n = 66): GFR <30 mL/min/1.73 m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints. Results: The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively (p < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; p < 0.0001) and long-term (34% vs. 13%; p < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; p < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; p < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission.
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Cosentino et al. (2020) conducted an observational in acute myocardial infarction (n=2,445). Reduced glomerular filtration rate (GFR ≤60 mL/min/1.73 m²) vs. Normal or mildly reduced glomerular filtration rate (GFR >60 mL/min/1.73 m²) was evaluated on Incidence of new-onset atrial fibrillation during AMI hospitalization (p=<0.0001). The incidence of new-onset atrial fibrillation during acute myocardial infarction increased significantly as glomerular filtration rate declined, occurring in 8%, 16%, and 24% of patients with GFR >60, 60-30, and <30 mL/min/1.73 m², respectively.
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