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Zhou Y, Madsen JM, Özbek BT, Køber L, Bang LE, Lønborg JT, Engstrøm T. The role of remnant cholesterol in patients with ST-segment elevation myocardial infarction. Eur J Prev Cardiol 2024; 31:1227-1237. [PMID: 38447015 DOI: 10.1093/eurjpc/zwae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
AIMS Remnant cholesterol (RC) is the cholesterol content within triglyceride-rich lipoproteins. It promotes atherosclerotic cardiovascular disease beyond LDL cholesterol (LDL-C). The prognostic role of RC in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We aimed to estimate RC-related risk beyond LDL-C in patients with STEMI. METHODS AND RESULTS A total of 6602 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) from 1999 to 2016 were included. Remnant cholesterol was calculated as total cholesterol minus LDL-C minus HDL cholesterol. Adjusted Cox models were used to estimate the association between continuous RC levels and all-cause mortality, cardiovascular death, ischaemic stroke, and recurrent myocardial infarction (MI) at long-term (median follow-up of 6.0 years). Besides, discordance analyses were applied to examine the risk of the discordantly high RC (RC percentile rank minus LDL-C percentile rank > 10 units) compared with the discordantly low RC (LDL-C percentile rank minus RC percentile rank > 10 units). The concordance was defined as the percentile rank difference between RC and LDL-C ≤ 10 units. The median age of patients was 63 years [interquartile range (IQR) 54-72] and 74.8% were men. There were 2441, 1651, and 2510 patients in the discordantly low RC group, concordant group, and discordantly high RC group, respectively. All outcomes in the discordantly high RC group were higher than the other groups, and the event rate of all-cause mortality in this group was 31.87%. In the unadjusted analysis, the discordantly high RC was associated with increased all-cause mortality [hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.63-2.04] and increased cardiovascular death (HR 1.79, 95% CI 1.55-2.06) compared with the discordantly low RC. In an adjusted model, RC was associated with higher all-cause mortality (HR 1.14, 95% CI 1.07-1.22). The discordantly high RC was associated with increased all-cause mortality (adjusted HR 1.55, 95% CI 1.37-1.75) and increased cardiovascular death (adjusted HR 1.47, 95% CI 1.25-1.72) compared with the discordantly low RC. There were no associations between RC and ischaemic stroke or recurrent MI. CONCLUSION In patients with STEMI treated with primary PCI, elevated RC levels beyond LDL-C and discordantly high RC were independently associated with increased all-cause mortality.
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Affiliation(s)
- Yan Zhou
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Graduate School of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Jasmine Melissa Madsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Burcu Tas Özbek
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lia Evi Bang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jacob Thomsen Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Zarei B, Bozorgi A, Khoshfetrat M, Arefizadeh R, Mohsenizadeh SA, Mousavi SH, Jalali A, Shafiee A. Incidence and predictors of new-onset atrial fibrillation in ST-elevation myocardial infarction: A single-center study. Health Sci Rep 2024; 7:e2226. [PMID: 38957860 PMCID: PMC11217016 DOI: 10.1002/hsr2.2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 06/05/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024] Open
Abstract
Background and Aims Atrial fibrillation (AF) is a common arrhythmia that occurs following ST-elevation myocardial infarction (STEMI) and can significantly impact clinical outcomes. We investigated the incidence and predictors of AF following STEMI in patients, as well as its association with major adverse cardiac and cerebrovascular events (MACCE). Methods We conducted a retrospective cohort study, including all STEMI patients who presented under code 247 to Tehran Heart Center between 2016 and 2020 and completed a 1-year follow-up. Patients were divided into two groups based on the development of AF during follow-up, and their baseline and clinical characteristics were compared. We used multivariable regression models to identify predictors of MACCE. Results Out of 3647 STEMI patients, 84 (2.3%) developed new-onset AF (NOAF). Patients with AF were significantly older and had lower levels of total and low-density lipoprotein cholesterol, triglyceride, and hemoglobin, but higher levels of fasting blood sugar and creatinine. AF patients were also more likely to have a history of hypertension, chronic kidney disease (CKD), congestive heart failure, and cerebrovascular accidents. The multivariable logistic regression model identified the CHA2DS2-VASc score and CKD as independent predictors of NOAF following primary percutaneous coronary intervention. Furthermore, the incidence of MACCE was higher in the AF group, and AF independently predicted MACCE with a hazard ratio of 2.766. Conclusion The CHA2DS2-VASc score and the presence of CKD can serve as useful predictors of NOAF among patients with STEMI. Early detection and appropriate management are crucial to improve outcomes.
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Affiliation(s)
- Behrouz Zarei
- Department of Cardiology, School of MedicineAJA University of Medical SciencesTehranIran
| | - Ali Bozorgi
- Department of Cardiology, Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Mehran Khoshfetrat
- Department of Cardiology, School of MedicineAJA University of Medical SciencesTehranIran
| | - Reza Arefizadeh
- Department of Cardiology, School of MedicineAJA University of Medical SciencesTehranIran
| | | | - Seyyed Hossein Mousavi
- Department of Cardiology, School of MedicineAJA University of Medical SciencesTehranIran
| | - Arash Jalali
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Akbar Shafiee
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
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Shakeel I, Sharma H, Hodson J, Iqbal H, Tashfeen R, Ludman PF, Steeds RP, Townend JN, Doshi SN, Nadir MA. Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction. J Clin Med 2024; 13:2318. [PMID: 38673591 PMCID: PMC11050934 DOI: 10.3390/jcm13082318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
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.
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Affiliation(s)
- Iqra Shakeel
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
| | - Harish Sharma
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - James Hodson
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Hamna Iqbal
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
| | - Rashna Tashfeen
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
| | - Peter F. Ludman
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Richard P. Steeds
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Jonathan N. Townend
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Sagar N. Doshi
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - M. Adnan Nadir
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
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Chatterjee S, Ad N, Badhwar V, Gillinov AM, Alexander JH, Moon MR. Anticoagulation for atrial fibrillation after cardiac surgery: Do guidelines reflect the evidence? J Thorac Cardiovasc Surg 2024; 167:694-700. [PMID: 37037415 DOI: 10.1016/j.jtcvs.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/25/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex.
| | - Niv Ad
- Division of Cardiac Surgery, White Oak Medical Center, Adventist HealthCare, University of Maryland, Takoma Park, Md
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - John H Alexander
- Division of Cardiology, Duke University School of Medicine & Duke Clinical Research Institute, Durham, NC
| | - Marc R Moon
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
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Bao J, Gao Z, Hu Y, Liu W, Ye L, Wang L. Serum fibrinogen-to-albumin ratio predicts new-onset atrial fibrillation risk during hospitalization in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective study. BMC Cardiovasc Disord 2023; 23:432. [PMID: 37658287 PMCID: PMC10474692 DOI: 10.1186/s12872-023-03480-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) is a common adverse outcome of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and is closely correlated with hospital stay and prognosis. In recent years, serum fibrinogen-to-albumin ratio (FAR), a novel biomarker for inflammation and thrombosis, has been used to predict the severity and prognosis of coronary artery disease. Our study aimed to investigate the relationship between FAR and NOAF during hospitalization after PCI in patients with AMI. METHODS We retrospectively analyzed the incidence of NOAF during hospitalization and follow-up in 670 patients with AMI after PCI. Data were collected on patient age, sex, body mass index, medical history, current medication, heart failure, laboratory tests, culprit blood vessels, echocardiographic characteristics, and AMI type. The enrolled patients were divided into NOAF and non-NOAF groups. The baseline characteristics of patients in the two groups were compared, and the predictive correlation between FAR and NOAF was evaluated using logistic regression analysis and the receiver operating characteristic curve. RESULTS Fifty-three (7.9%) patients developed NOAF during hospitalization. The occurrence of NOAF was found to be independently associated with higher FAR besides older age, higher neutrophil count, greater left atrial size, worse Killip class upon admission, lower body mass index, lower platelet count, lower left ventricle ejection fraction, and target left circumflex artery disease. FAR exhibited a better predictive value for the occurrence of NOAF during hospitalization (area under the curve, 0.732; 95% confidence interval, 0.659-0.808). CONCLUSIONS FAR is a robust tool for predicting NOAF risk during hospitalization in patients with AMI after PCI and has a better predictive value than serum fibrin and serum albumin levels alone.
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Affiliation(s)
- Jiaqi Bao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhicheng Gao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yilan Hu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wenquan Liu
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Lifang Ye
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Lihong Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China.
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Xie X, Chen Y, Gan W, Liang C, Zuo Q, Zhou Y, Cheng Y, Wang X, Luo Z, Tang S, Ling Y. Relationship Between Prognostic Nutritional Index and New-Onset Atrial Fibrillation in Patients with Acute ST-Elevation Myocardial Infarction Following Percutaneous Coronary Intervention. Int Heart J 2023; 64:543-550. [PMID: 37460321 DOI: 10.1536/ihj.22-647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Multiple reports relate new-onset atrial fibrillation (NOAF) to poor clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) who received percutaneous coronary intervention (PCI). The prognostic nutritional index (PNI) is a reliable indicator of immunonutritional-inflammatory status, and it is linked to clinical outcomes in cardiovascular disease patients. This research aims to explore the relationship between NOAF and PNI.Overall, 600 STEMI patients treated with PCI were recruited for this retrospective analysis. The patients were categorized into the NOAF group or sinus rhythm (SR) group. Logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to assess PNI estimation. Lastly, the Kaplan-Meier curve was used to compare all-cause mortality between both groups.The combined NOAF incidence in PCI-treated STEMI patients was 7.7%. PNI was independently correlated with NOAF using multivariate regression analyses (odds ratio [OR], 0.824; 95% confidence interval [CI], 0.750-0.906; P < 0.001). In ROC curve analyses, the best PNI threshold value for predicting NOAF was 40.1, with sensitivity, and specificity of 76.09% and 71.30%, respectively area under the curve, 0.787; 95% CI, 0.752-0.819; P < 0.001). After a median of 41-month follow-up, the Kaplan-Meier curve revealed that the NOAF patients displayed an elevated all-cause death incidence compared with SR patients, with a log-rank of P = 0.005.This study demonstrated that PNI is an independent predictor of NOAF in STEMI patients during hospitalization after PCI, which is strongly correlated with a poor outcome upon discharge.
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Affiliation(s)
- Xiangrong Xie
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Yan Chen
- Department of Cardiology, Taishan People's Hospital
| | - Weipeng Gan
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Cheng Liang
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Quan Zuo
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Yimeng Zhou
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Yuliang Cheng
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Xinyu Wang
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Zhimin Luo
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Shengxing Tang
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
| | - Yang Ling
- Department of Cardiology, Yijishan Hospital, Wannan Medical College
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Thomsen AF, Jøns C, Jabbari R, Jacobsen MR, Stampe NK, Butt JH, Olsen NT, Kelbæk H, Torp-Pedersen C, Fosbøl EL, Pedersen F, Køber L, Engstrøm T, Jacobsen PK. Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status. Europace 2023; 25:931-939. [PMID: 36520640 PMCID: PMC10062371 DOI: 10.1093/europace/euac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia. METHODS AND RESULTS Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07-1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00-1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10-2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05-1.53; P = 0.01). All HRs adjusted. CONCLUSION Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR.
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Affiliation(s)
- Anna F Thomsen
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mia R Jacobsen
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand University Hospital, Dyrehavevej 29, 3400 Hilleroed, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
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8
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Wu N, Li J, Xu X, Yuan Z, Yang L, Chen Y, Xia T, Hu Q, Chen Z, Li C, Xiang Y, Zhang Z, Zhong L, Li Y. Prediction Model of New Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome. Int J Clin Pract 2023; 2023:3473603. [PMID: 36874383 PMCID: PMC9981295 DOI: 10.1155/2023/3473603] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is one of the most common complications of acute coronary syndrome (ACS) patients. Possible risk factors related to new-onset AF (NOAF) in ACS patients have been reported in some studies, and several prediction models have been established. However, the predictive power of these models was modest and lacked independent validation. The aim of this study is to define risk factors of NOAF in patients with ACS during hospitalization and to develop a prediction model and nomogram for individual risk prediction. METHODS Retrospective cohort studies were conducted. A total of 1535 eligible ACS patients from one hospital were recruited for model development. External validation was performed using an external cohort of 1635 ACS patients from another hospital. The prediction model was created using multivariable logistic regression and validated in an external cohort. The discrimination, calibration, and clinical utility of the model were evaluated, and a nomogram was constructed. A subgroup analysis was performed for unstable angina (UA) patients. RESULTS During hospitalization, the incidence of NOAF was 8.21% and 6.12% in the training and validation cohorts, respectively. Age, admission heart rate, left atrial diameter, right atrial diameter, heart failure, brain natriuretic peptide (BNP) level, less statin use, and no percutaneous coronary intervention (PCI) were independent predictors of NOAF. The AUC was 0.891 (95% CI: 0.863-0.920) and 0.839 (95% CI: 0.796-0.883) for the training and validation cohort, respectively, and the model passed the calibration test (P > 0.05). The clinical utility evaluation shows that the model has a clinical net benefit within a certain range of the threshold probability. CONCLUSION A model with strong predictive power was constructed for predicting the risk of NOAF in patients with ACS during hospitalization. It might help with the identification of ACS patients at risk and early intervention of NOAF during hospitalization.
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Affiliation(s)
- Na Wu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Junzheng Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Xiang Xu
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Zhiquan Yuan
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Lili Yang
- Department of Information, Xinqiao Hospital, Army Medical University, Chongqing 400038, China
| | - Yanxiu Chen
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Tingting Xia
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Qin Hu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Zheng Chen
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Chengying Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Ying Xiang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
| | - Zhihui Zhang
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Li Zhong
- Cardiovascular Disease Center, Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing 400038, China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University, Chongqing 400038, China
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9
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Wang J, Hu S, Liang C, Ling Y. The association between systemic inflammatory response index and new-onset atrial fibrillation in patients with ST-elevated myocardial infarction treated with percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:525. [PMID: 36474135 PMCID: PMC9724303 DOI: 10.1186/s12872-022-02989-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) complicating with ST-elevated myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI) is associated with worse prognosis. The systemic inflammatory response index (SIRI), serves as a novel inflammatory indicator, is found to be predictive of adverse outcomes. The aim of this study is to explore the association between NOAF and SIRI. METHODS A retrospective data included 616 STEMI participants treated with PCI in our cardiology department had been analyzed in present investigation, of which being divided into a NOAF or sinus rhythm (SR) group based on the presence or absence of atrial fibrillation. The predictive role of SIRI for in detecting NOAF had been evaluated by the logistic regression analyses and receiver operating characteristic (ROC) curve. Additionally, long-term all-cause mortality between both groups was compared using the Kaplan-Meier test. RESULTS NOAF during hospitalization developed in 7.6% of PCI-treated individuals. After multivariate regression analyses, SIRI remains to be an independently predictor of NOAF (odds ratio 1.782, 95% confidence interval 1.675-1.906, P = 0.001). In the ROC curve analysis, SIRI with a cut-off value of 4.86 was calculated to predict NOAF, with 4.86, with a sensitivity of 80.85% and a specificity of 75.57%, respectively (area under the curve (AUC) = 0.826, P < 0.001). Furthermore, pairwise compassion of ROC curves displayed the superiority of SIRI in the prediction of NOAF in comparison with that of neutrophil/lymphocyte or monocyte/lymphocyte (P < 0.05). In addition, the participants in NOAF group had a significantly higher incidence of all-cause death compared to those in SR group after a median of 40-month follow-up (22.0% vs 5.8%, log-rank P < 0.001). CONCLUSION SIRI can independently predict NOAF in patients with STEMI after PCI, with being positively correlated to worsened outcomes.
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Affiliation(s)
- Jingfeng Wang
- grid.443626.10000 0004 1798 4069Department of Cardiology, Yijishan Hospital Affiliated to Wannan Medical College, 2# West Zhe Shan Road, Wuhu, 241000 China
| | - Sisi Hu
- grid.443626.10000 0004 1798 4069Department of Cardiology, Yijishan Hospital Affiliated to Wannan Medical College, 2# West Zhe Shan Road, Wuhu, 241000 China
| | - Cheng Liang
- grid.443626.10000 0004 1798 4069Department of Cardiology, Yijishan Hospital Affiliated to Wannan Medical College, 2# West Zhe Shan Road, Wuhu, 241000 China
| | - Yang Ling
- grid.443626.10000 0004 1798 4069Department of Cardiology, Yijishan Hospital Affiliated to Wannan Medical College, 2# West Zhe Shan Road, Wuhu, 241000 China
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10
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Yu S, Li C, Guo H. Oral anticoagulant therapy for patients with new-onset atrial fibrillation following acute myocardial infarction: A narrative review. Front Cardiovasc Med 2022; 9:1046298. [DOI: 10.3389/fcvm.2022.1046298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTo evaluate the advantages and disadvantages of anticoagulant therapy and provide a piece of information on anti-thrombotic treatment strategies for patients with new-onset atrial fibrillation (NOAF) and acute myocardial infarction (AMI).MethodsLiterature from PubMed and Google scholar were screened until August 2022. Studies assessing oral anticoagulant (OAC) treatments for NOAF in patients with AMI were evaluated for inclusion.ResultsThree retrospective cohort studies were included. In the study performed by Madsen et al., patients with previously diagnosed AMI with or without NOAF were followed up for 5.8 years. About 38% of NOAF patients with anticoagulant therapies, which could reduce long-term mortality [adjusted hazard ratio (HR): 0.69; 95% confidence interval (CI): 0.47–1.00]. Hofer et al. performed a single-center cohort study containing 1,372 patients with AMI with an 8.6-year follow-up period. Dual anti-thrombotic therapy (DAT) did not show the effect on the survival in NOAF (adjusted HR: 0.97; 95% CI: 0.65–1.57), while triple antithrombotic therapy (TAT) could reduce long-term cardiovascular mortality (adjusted HR: 0.86; 95% CI: 0.45–0.92). Petersen et al. also did a cohort study with 1-year follow-up duration. It showed that anticoagulant therapies demonstrated positive results (HR: 0.78; 95% CI: 0.41–1.47).ConclusionRecent studies have shown that anticoagulant therapy in AMI-NOAF patients can obviously reduce the mortality of AMI-NOAF patients, especially OAC therapy. Further clinical trials could confirm these findings.
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11
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Ling Y, Fu C, Fan Q, Liu J, Jiang L, Tang S. Triglyceride-Glucose Index and New-Onset Atrial Fibrillation in ST-Segment Elevation Myocardial Infarction Patients After Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:838761. [PMID: 35345486 PMCID: PMC8957253 DOI: 10.3389/fcvm.2022.838761] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/04/2022] [Indexed: 01/02/2023] Open
Abstract
Background New-onset atrial fibrillation (NOAF) is associated with worse prognostic outcomes in cases diagnosed with ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, as a credible and convenient marker of insulin resistance, has been shown to be predictive of outcomes for STEMI patients following revascularization. The association between TyG index and NOAF among STEMI patients following PCI, however, has not been established to date. Objective To assess the utility of the TyG index as a predictor of NOAF incidence in STEMI patients following PCI, and to assess the relationship between NOAF and long-term all-cause mortality. Methods This retrospective cohort research enrolled 549 STEMI patients that had undergone PCI, with these patients being clustered into the NOAF group and sinus rhythm (SR) group. The predictive relevance of TyG index was evaluated through logistic regression analyses and the receiver operating characteristic (ROC) curve. Kaplan-Meier curve was employed to explore differences in the long-term all-cause mortality between the NOAF and SR group. Results NOAF occurred in 7.7% of the enrolled STEMI patients after PCI. After multivariate logistic regression analysis, the TyG index was found to be an independent predictor of NOAF [odds ratio (OR): 8.884, 95% confidence interval (CI): 1.570–50.265, P = 0.014], with ROC curve analyses further supporting the predictive value of this parameter, which exhibited an area under ROC curve of 0.758 (95% CI: 0.720–0.793, P < 0.001). All-cause mortality rates were greater for patients in the NOAF group in comparison with the SR group over a median 35-month follow-up period (log-rank P = 0.002). Conclusions The TyG index exhibits values as an independent predictor of NOAF during hospitalization, which indicated a poorer prognosis after a relatively long-term follow-up.
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Affiliation(s)
- Yang Ling
- Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Cong Fu
- Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Qun Fan
- Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Jichun Liu
- Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Ling Jiang
- Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Shengxing Tang
- Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, China
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12
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Bor WL, Ten Berg JM. Known or new atrial fibrillation in patients with acute coronary syndrome: what's the difference? Eur Heart J 2021; 42:4562-4564. [PMID: 34586404 DOI: 10.1093/eurheartj/ehab689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
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13
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Fragão-Marques M, Teixeira F, Mancio J, Seixas N, Rocha-Neves J, Falcão-Pires I, Leite-Moreira A. Impact of oral anticoagulation therapy on postoperative atrial fibrillation outcomes: a systematic review and meta-analysis. Thromb J 2021; 19:89. [PMID: 34798896 PMCID: PMC8603521 DOI: 10.1186/s12959-021-00342-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Post-operative atrial fibrillation (POAF) is the most common complication after cardiac surgery. Recent studies had shown this phenomenon is no longer considered transitory and is associated with higher risk of thromboembolic events or death. The aim of this study was to systematically review and analyze previous studies comparing oral anticoagulation therapy with no anticoagulation, regarding these long-term outcomes. METHODS PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Database were systematically searched to identify the studies comparing the risk of stroke, or thromboembolic events or mortality of POAF patients who received anticoagulation compared with those who were not anticoagulated. Incidence of stroke, thromboembolic events and all-cause mortality were evaluated up to 10 years after surgery. Time-to-event outcomes were collected through hazard ratio (HR) along with their variance and the early endpoints using frequencies or odds ratio (OR). Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI). Heterogeneity was evaluated through Q statistic-related measures of variance (Tau2, I2, Chi-squared test). RESULTS Eight observational cohort studies were selected, including 15,335 patients (3492 on Oral Anticoagulants (OAC) vs 11,429 without OAC) that met the inclusion criteria for qualitative synthesis. Patients had a wide gender distribution (38.6-82.3%), each study with a mean age above 65 years (67.5-85). Vitamin K antagonists were commonly prescribed anticoagulants (74.3-100%). OAC was associated with a protective impact on all-cause mortality at a mean of 5.0 years of follow-up (HR is 0.85 [0.72-1.01]; p = 0.07; I2 = 48%). Thromboembolic events did not differ between the two treatment arms (HR 0.68 [0.40-1.15], p = 0.15). CONCLUSION Current literature suggests a possibly protective impact of OAC therapy for all-cause mortality in patients with new-onset atrial fibrillation after cardiac surgery. However, it does not appear to impact thromboembolism rate.
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Affiliation(s)
- Mariana Fragão-Marques
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal.
- São João University Hospital Center, Porto, Portugal.
- Faculty of Medicine of the University of Porto, Porto, Portugal.
| | | | - Jennifer Mancio
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Nair Seixas
- Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - João Rocha-Neves
- São João University Hospital Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal
- São João University Hospital Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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14
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Yi JE, Seo SM, Lim S, Choo EH, Choi IJ, Lee KY, Hwang BH, Kim CJ, Park MW, Kim DB, Her SH, Lee JM, Park CS, Kim PJ, Kim HY, Yoo KD, Jeon DS, Chung WS, Jeong MH, Ahn Y, Chang K. Gender Differences in the Impact of New-Onset Atrial Fibrillation on Long-Term Risk of Ischemic Stroke after Acute Myocardial Infarction. J Clin Med 2021; 10:jcm10215141. [PMID: 34768661 PMCID: PMC8584956 DOI: 10.3390/jcm10215141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) has been identified as a major risk factor for mortality after acute coronary syndrome (ACS). However, the long-term risk of ischemic stroke associated with new-onset atrial fibrillation (NOAF) in ACS remains controversial, and its gender-specific association is unknown. METHODS We analyzed the data of 10,137 ACS survivors included in a multicenter, prospective registry for Korean patients with acute myocardial infarction (AMI) between January 2004 and August 2014. Subjects were categorized into three groups (non-AF vs. NOAF vs. previous AF) based on medical history and electrocardiographic evidence of AF, either at admission or during hospitalization. RESULTS Among the total study population (72.3% men), 370 patients (3.6%) had NOAF and 130 (1.3%) had previous AF. During a median follow-up of 61 months (interquartile range, 38.8 to 89.3 months), 245 (2.4%) patients (218 (2.3%) non-AF vs. 15 (4.1%) NOAF vs. 12 (9.2%) previous AF, p < 0.001) experienced ischemic stroke. After adjustment for confounding variables, both NOAF (adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09-3.24, p = 0.024) and previous AF (adjusted HR 4.00, 95% CI 2.03-7.87, p < 0.001), along with older age, diabetes, current smoker, and previous stroke were independent risk factors of ischemic stroke. In the gender-stratified analysis, men with previous AF but not NOAF had a significantly higher risk of ischemic stroke (adjusted HR 4.14, 95% CI 1.79-9.55, p = 0.001) than those without AF. In women, NOAF (adjusted HR 2.54, 95% CI 1.21-5.35, p = 0.014) as well as previous AF (adjusted HR 3.72, 95% CI 1.16-11.96, p = 0.028) was a strong predictor of ischemic stroke, and the predictive value was comparable to that of previous AF among patients with a CHA2DS2-VASc score ≥ 2. CONCLUSIONS Both NOAF and previous AF were associated with ischemic stroke after AMI, but the impact of NOAF as a risk factor of ischemic stroke was significant only in women.
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Affiliation(s)
- Jeong-Eun Yi
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
| | - Suk-Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
- Correspondence: ; Tel.: +82-2-2030-2599
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Ik-Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (I.-J.C.); (D.-S.J.)
| | - Kwan-Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Chan-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-B.K.); (H.-Y.K.)
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.H.); (K.-D.Y.)
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Pum-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
| | - Hee-Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-B.K.); (H.-Y.K.)
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.H.); (K.-D.Y.)
| | - Doo-Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (I.-J.C.); (D.-S.J.)
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Myung-Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61748, Korea; (M.-H.J.); (Y.A.)
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61748, Korea; (M.-H.J.); (Y.A.)
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
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