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Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction.
Shakeel, Iqra; Sharma, Harish; Hodson, James; Iqbal, Hamna; Tashfeen, Rashna; Ludman, Peter F; Steeds, Richard P; Townend, Jonathan N; Doshi, Sagar N; Nadir, M Adnan.
Affiliation
  • Shakeel I; College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
  • Sharma H; College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
  • Hodson J; Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK.
  • Iqbal H; Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK.
  • Tashfeen R; College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
  • Ludman PF; College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
  • Steeds RP; College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
  • Townend JN; Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK.
  • Doshi SN; College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
  • Nadir MA; Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK.
J Clin Med ; 13(8)2024 Apr 17.
Article in En | MEDLINE | ID: mdl-38673591
ABSTRACT

Background:

Concomitant atrial fibrillation (AF) is associated with an adverse prognosis in patients with acute myocardial infarction (MI). However, it remains unclear whether this is due to a causal effect of AF or whether AF acts as a surrogate marker for comorbidities in this population. Furthermore, there are limited data on whether coronary artery disease distribution impacts the risk of developing AF.

Methods:

Consecutive patients admitted with acute MI and treated using percutaneous coronary intervention (PCI) at a single centre were retrospectively identified. Associations between AF and major adverse cardiac and cerebrovascular events (MACCEs) over a median of five years of follow-up were assessed using Cox regression, with adjustment for confounding factors performed using both multivariable modelling and a propensity-score-matched analysis.

Results:

AF was identified in N = 65/1000 (6.5%) of cases; these patients were significantly older (mean 73 vs. 65 years, p < 0.001), with lower creatinine clearance (p < 0.001), and were more likely to have a history of cerebrovascular disease (p = 0.011) than those without AF. In addition, patients with AF had a greater propensity for left main stem (p = 0.001) or left circumflex artery (p = 0.004) involvement. Long-term MACCE rates were significantly higher in the AF group than in the non-AF group (50.8% vs. 34.2% at five years), yielding an unadjusted hazard ratio (HR) of 1.86 (95% CI 1.32-2.64, p < 0.001). However, after adjustment for confounding factors, AF was no longer independently associated with MACCEs, either on multivariable (adjusted HR 1.25, 95% CI 0.81-1.92, p = 0.319) or propensity-score-matched (HR 1.04, 95% CI 0.59-1.82, p = 0.886) analyses.

Conclusions:

AF is observed in 6.5% of patients admitted with acute MI, and those with AF are more likely to have significant diseases involving left main or circumflex arteries. Although unadjusted MACCE rates were significantly higher in patients with AF, this effect was not found to remain significant after adjustment for comorbidities. As such, this study provided no evidence to suggest that AF is independently associated with MACCEs.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Clin Med Year: 2024 Type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Clin Med Year: 2024 Type: Article