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Guo X, Huang T, Xu Y, Zhao J, Huang Y, Zhou Z, Xing B, Li Y, Meng S, Chen X, Yu L, Wang H. Early inhibition of the ATM/p53 pathway reduces the susceptibility to atrial fibrillation and atrial remodeling following acute myocardial infarction. Cell Signal 2024; 122:111322. [PMID: 39067835 DOI: 10.1016/j.cellsig.2024.111322] [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: 06/11/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Atrial fibrillation (AF) emerges as a critical complication following acute myocardial infarction (AMI) and is associated with a significant increased risk of heart failure, stroke and mortality. Ataxia telangiectasia mutated (ATM), a key player in DNA damage repair (DDR), has been implicated in multiple cardiovascular conditions, however, its involvement in the development of AF following AMI remains unexplored. This study seeks to clarify the contribution of the ATM/p53 pathway in the onset of AF post-AMI and to investigate the underlying mechanisms. The rat model of AMI was established by ligating left anterior descending coronary artery in the presence or absence of Ku55933 (an ATM kinase inhibitor, 5 mg/kg/d) treatment. Rats receiving Ku55933 were further divided into the early administration group (administered on days 1, 2, 4, and 7 post-AMI) and the late administration group (administered on days 8, 9, 11 and 14 post-AMI). RNA-sequencing was performed 14 days post-operation. In vitro, H2O2-challenged HL-1 atrial muscle cells were utilized to evaluate the potential effects of different ATM inhibition schemes, including earlier, middle, and late periods of intervention. Fourteen days post-AMI injury, the animals exhibited significantly increased AF inducibility, exacerbated atrial electrical/structural remodeling, reduced ventricular function and exacerbated atrial DNA damage, as evidenced by enhanced ATM/p53 signaling as well as γH2AX level. These effects were partially consistent with the enrichment results of bioinformatics analysis. Notably, the deleterious effects were ameliorated by early, but not late, administration of Ku55933. Mechanistically, inhibition of ATM signaling successfully suppressed atrial NLRP3 inflammasome-mediated pyroptotic pathway. Additionally, the results were validated in the in vitro experiments demonstrating that early inhibition of Ku55933 not only attenuated cellular ATM/p53 signaling, but also mitigated inflammatory response by reducing NLRP3 activation. Collectively, hyperactivation of ATM/p53 contributed to the pathogenesis of AF following AMI. Early intervention with ATM inhibitors substantially mitigated AF susceptibility and atrial electrical/structural remodeling, highlighting a novel therapeutic avenue against cardiac arrhythmia following AMI.
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Affiliation(s)
- Xiaodong Guo
- Graduate School of Dalian Medical University, Dalian 116000, Liaoning Province, China; State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Tao Huang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Yinli Xu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Jikai Zhao
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Yuting Huang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Zijun Zhou
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Bo Xing
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Yao Li
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Shan Meng
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Xin Chen
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Liming Yu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China.
| | - Huishan Wang
- Graduate School of Dalian Medical University, Dalian 116000, Liaoning Province, China; State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China.
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2
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Popovic B, Varlot J, Humbertjean L, Sellal JM, Pace N, Hammache N, Fay R, Eggenspieler F, Metzdorf PA, Camenzind E. Coronary Embolism Among Patients With ST-Segment-Elevation Myocardial Infarction and Atrial Fibrillation: An Underrecognized But Deadly Association. J Am Heart Assoc 2024; 13:e032199. [PMID: 38742522 PMCID: PMC11179809 DOI: 10.1161/jaha.123.032199] [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: 08/17/2023] [Accepted: 02/27/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The prevalence and impact of coronary emboli (CE) in patients with ST-segment-elevation myocardial infarction (STEMI) and atrial fibrillation (AF) have not been specifically studied. The objective was to describe the clinical characteristics and outcomes of patients with AF and CE in a large series of patients with STEMI. METHODS AND RESULTS We investigated 2292 consecutive patients with STEMI and among them 225 patients with AF: 46 patients with a STEMI related to CE (group A) and 179 patients with a STEMI related to an atherosclerotic cause (group B). Compared with the 2067 patients without AF and CE (group C), patients with AF and CE were older (73 versus 59 years, P<0.05), more likely to be female (43% versus 22%, P<0.05), and presented more frequently with cardiogenic shock at admission (26% versus 9%, P<0.05). The baseline characteristics of patients with AF (group A versus B) did not differ significantly according to STEMI pathogenesis. In the unadjusted analysis, the 45-day mortality was higher in patients with CE and AF (group A versus group C: 20% versus 4%; P<0.05 and group A versus group B: 20% versus 8%, P=not significant); this trend persisted at 2-year follow-up (group A versus group C: 24% versus 6%; P<0.05 and group A versus group B: 24% versus 17%, P=not significant). After stabilized inverse exposure probability weighting adjustment, a higher 45-day mortality rate was confirmed in patients with CE and AF (group A versus group C: 18% versus 5%, P<0.05). CONCLUSIONS In patients presenting with STEMI and AF, CE was associated with excess early mortality. REGISTRATION URL: clinicaltrials.gov. Identifier: NCT05679843.
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Affiliation(s)
- Batric Popovic
- Department of Cardiology Université de Lorraine, CHRU-Nancy Nancy France
| | - Jeanne Varlot
- Department of Cardiology Université de Lorraine, CHRU-Nancy Nancy France
| | - Lisa Humbertjean
- Stroke Unit, Department of Neurology Université de Lorraine, CHRU-Nancy Nancy France
| | - Jean Marc Sellal
- Department of Cardiology Université de Lorraine, CHRU-Nancy Nancy France
| | - Nathalie Pace
- Department of Cardiology Université de Lorraine, CHRU-Nancy Nancy France
| | - Nefissa Hammache
- Department of Cardiology Université de Lorraine, CHRU-Nancy Nancy France
| | - Renaud Fay
- Department of Cardiology Université de Lorraine, CHRU-Nancy Nancy France
| | | | | | - Edoardo Camenzind
- Department of Cardiology Université de Lorraine, CHRU-Nancy Nancy France
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3
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Balogh L, Óvári P, Ugbodaga CU, Csanádi Z. Atrial Fibrillation Related Coronary Embolism: Diagnosis in the Focus. J Pers Med 2023; 13:jpm13050780. [PMID: 37240950 DOI: 10.3390/jpm13050780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in myocardial infarction (MI). AF can be caused by ischemia, and MI can be caused by AF. Additionally, 4-5% of MI cases are related to coronary embolism (CE), and one-third of cases are attributed to AF. Our aim was to investigate the prevalence of AF-related CE cases among 3 consecutive years of STEMI cases. We also aimed to reveal the diagnostic accuracy of the Shibata criteria scoring system and the role of thrombus aspiration. Among 1181 STEMI patients, 157 had AF (13.2%). By using the Shibata's diagnostic criteria, 10 cases were classified as 'definitive' and 31 as 'probable' CE. After re-evaluation, a further five cases were classified as 'definitive'. Further analysis of the 15 CE cases revealed that CE was more prevalent in patients with previously known (n = 10) compared to those with new-onset (n = 5) AF (16.7% vs. 5.1%, p = 0.024). A PubMed search was performed, and 40 AF-related cases were found where the Shibata's criteria could be applied. Further, 31 cases could be classified as 'definitive', 4 as 'probable' and, in 5 cases, the embolic origin could be excluded. In 40% of reported cases and in 47% of our cases, thrombus aspiration helped in diagnosis.
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Affiliation(s)
- László Balogh
- Department of Cardiology and Cardiac Surgery, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Péter Óvári
- Department of Cardiology and Cardiac Surgery, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Christopher Uwaafo Ugbodaga
- Department of Cardiology and Cardiac Surgery, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Zoltán Csanádi
- Department of Cardiology and Cardiac Surgery, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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4
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Carnicelli AP, Owen R, Pocock SJ, Brieger DB, Yasuda S, Nicolau JC, Goodman SG, Cohen MG, Simon T, Westermann D, Hedman K, Andersson Sundell K, Granger CB. Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction. Open Heart 2021; 8:openhrt-2021-001726. [PMID: 34911791 PMCID: PMC8679122 DOI: 10.1136/openhrt-2021-001726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Atrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF. Methods/results The prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality. Conclusions In stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF. Trial registration number ClinicalTrials: NCT01866904.
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Affiliation(s)
| | - Ruth Owen
- London School of Hygiene & Tropical Medicine, London, UK
| | - Stuart J Pocock
- Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David B Brieger
- Cardiology, Concord Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jose Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo Instituto do Coracao, Sao Paulo, Brazil
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Mauricio G Cohen
- Cardiovascular Division Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Assistance Publique - Hopitaux de Paris, Paris, France.,Clinical Pharmacology-Research Platform (UPMC-Paris 06), Sorbonne Université, Paris, France
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Partner Site Hamburg/Lübeck/Kiel, German Center for Cardiovascular Research (DZHK), Hamburg, Germany
| | | | | | - Christopher B Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Campia U, Rizzo SM, Snyder JE, Pfefferman MA, Morrison RB, Piazza G, Goldhaber SZ. Impact of Atrial Fibrillation on In-Hospital Mortality and Stroke in Acute Aortic Syndromes. Am J Med 2021; 134:1419-1423. [PMID: 34242621 DOI: 10.1016/j.amjmed.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute aortic syndromes may present with a number of cardiovascular complications, including atrial fibrillation. We assessed the prevalence of atrial fibrillation in patients presenting with acute aortic syndromes and evaluated atrial fibrillation's association with in-hospital mortality and stroke. METHODS Consecutive patients with acute aortic syndromes admitted to a single tertiary care center from January 2015 to March 2020 were included. We identified patients with atrial fibrillation on the presenting electrocardiogram. RESULTS A total of 309 patients with acute aortic syndromes were included in our analyses: 148 (48%) presented with Stanford type A and 161 (52%) with Stanford type B acute aortic syndromes. Twenty-seven (8.7%) patients had atrial fibrillation on the presenting electrocardiogram: 12 (44%) with type A and 15 (56%) with type B acute aortic syndromes. Patients with atrial fibrillation were older, more likely to be white, had a higher frequency of history of cancer, peripheral artery disease, cerebrovascular disease, and heart failure with preserved ejection fraction, compared with those without atrial fibrillation. Acute aortic syndromes patients with atrial fibrillation had higher frequencies of in-hospital mortality compared with those without atrial fibrillation (40.7% vs 12.4%, P < .0001). However, stroke frequencies did not differ between the 2 groups. CONCLUSION In patients presenting with acute aortic syndromes and atrial fibrillation, we observed higher frequencies of in-hospital mortality, without differences in the frequencies of stroke.
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Affiliation(s)
- Umberto Campia
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Samantha M Rizzo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Julia E Snyder
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Mariana A Pfefferman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ruth B Morrison
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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6
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Savic L, Mrdovic I, Asanin M, Stankovic S, Krljanac G, Lasica R, Viduljevic M. Impact of kidney function on the occurrence of new-onset atrial fibrillation in patients with ST-elevation myocardial infarction. Anatol J Cardiol 2021; 25:638-645. [PMID: 34498595 DOI: 10.5152/anatoljcardiol.2021.35332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, we aimed to examine the prognostic impact of decreased kidney function at admission on the occurrence of new-onset atrial fibrillation (AF) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). METHODS The study enrolled 3,115 consecutive patients with STEMI. Kidney function was assessed by estimation of the glomerular filtration rate (eGFR) at admission. Patients with cardiogenic shock at admission, patients on hemodialysis, and patients with a medical history of previous AF (paroxysmal, persistent, or permanent) were excluded. The follow-up period was six years. RESULTS New-onset AF occurred in 215 (6.9%) patients, 75 (34.9%) patients presented with AF, and 140 (65.1%) patients developed AF after pPCI. The median time of AF occurrence in patients who did not present with AF was 4.5 (interquartile range 1-25) hours after pPCI. New-onset AF was associated with a higher short- and long-term mortality. In the multiple logistic regression analysis, all stages of reduced kidney function were independent predictors for the occurrence of new-onset AF, and negative prognostic impact increased with the deterioration of kidney function: eGFR <90 mL/min/m2, hazard ratio (HR) 1.96, 95% confidence interval (CI) 1.42-2.89, p=0.011; eGFR 60-89 mL/min/m2, HR 1.54, 95% CI 1.13-2.57, p=0.045; eGFR 45-59 mL/min/m2-, HR 2.09, 95% CI 1.24-2.85, p=0.023; eGFR 30-44 mL/min/m2-, HR 2.93, 95% CI 1.64-5.29, p<0.001; eGFR 15-29 mL/min/m2-, HR 5.51, 95% CI 2.67-11.39, p<0.001. CONCLUSION Decreased kidney function was significantly associated with the occurrence of new-onset AF, and its impact increased with the deterioration in kidney function, starting with an eGFR value of 90 mL/min/m2. New-onset AF was an independent predictor of long-term all-cause mortality in the analyzed patients.
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Affiliation(s)
- Lidija Savic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Igor Mrdovic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Milika Asanin
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Emergency Hospital, University Clinical Center of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Ratko Lasica
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Mihajlo Viduljevic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
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7
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Tisminetzky M, Mehawej J, Miozzo R, Gurwitz JH, Gore JM, Lessard D, Abu HO, Bamgbade BA, Yarzebski J, Granillo E, Goldberg RJ. Temporal Trends and Patient Characteristics Associated with 30-Day Hospital Readmission Rates after a First Acute Myocardial Infarction. Am J Med 2021; 134:1127-1134. [PMID: 33864760 PMCID: PMC8410623 DOI: 10.1016/j.amjmed.2021.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are re-hospitalized after hospital admission for an acute myocardial infarction. This study examined trends in the frequency and sociodemographic and clinical characteristics of patients readmitted to the hospital within 30 days after an initial acute myocardial infarction. METHODS We reviewed the medical records of 3116 individuals who were hospitalized for a validated first acute myocardial infarction in 6 study periods between 2003 and 2015 at the 3 major medical centers in central Massachusetts. RESULTS The median age of our population was 67 years, and 42% were women. The risk of being readmitted to the hospital within 30 days after an initial acute myocardial infarction increased slightly during the most recent study years after controlling for potentially confounding factors. Overall, older adults and patients with previously diagnosed atrial fibrillation, heart failure, diabetes, chronic kidney disease, stroke, and peripheral vascular disease were at higher risk for being readmitted to the hospital than respective comparison groups. For those hospitalized in the most recent study years of 2011/2015, a higher risk of rehospitalization was associated with a previous diagnosis of chronic kidney disease, peripheral vascular disease, the presence of 3 or more chronic conditions, and having developed atrial fibrillation or heart failure during the patient's hospitalization for a first acute myocardial infarction. CONCLUSIONS We identified several groups at higher risk for hospital readmission in whom enhanced surveillance efforts as well as tailored educational and treatment approaches remain needed.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine; Department of Population and Quantitative Health Sciences.
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine; Department of Population and Quantitative Health Sciences
| | - Joel M Gore
- Department of Population and Quantitative Health Sciences; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | | | - Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester; Internal Medicine Department, Saint Vincent Hospital, Worcester, Mass
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Mass
| | | | | | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Mass; Department of Population and Quantitative Health Sciences
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8
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Patil S, Gonuguntla K, Rojulpote C, Kumar M, Nadadur S, Nardino RJ, Pickett C. Prevalence and Determinants of Atrial Fibrillation-Associated In-Hospital Ischemic Stroke in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2021; 144:1-7. [PMID: 33385356 DOI: 10.1016/j.amjcard.2020.12.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation (AF) is an established risk factor ischemic stroke (IS) and is commonly encountered in patient hospitalized with acute myocardial infarction (AMI). Uncommonly, IS can occur as a complication resulting from percutaneous coronary intervention (PCI). There is limited real world data regarding AF-associated in-hospital IS (IH-IS) in patients admitted with AMI undergoing PCI. We queried the National Inpatient Sample database from January 2010 to December 2014 to identify patients admitted with AMI who underwent PCI. In this cohort, we determined the prevalence of AF associated IH-IS and compared risk factors for IH-IS between patients with AF and without AF using multivariable logistic regression models. IH-IS was present in 0.46% (n = 5,938) of the patients with AMI undergoing PCI (n = 1,282,829). Prevalence of IH-IS in patients with AF was higher compared with patients without AF (1.05% vs 0.4%; adjusted odds ratio: 1.634, 95% confidence interval: 1.527 to 1.748, p <0.001). Regardless of AF status, prevalence and risk of IH-IS was higher in females and increased with advancing age. There was significant overlap among risk-factors associated with increased risk of IH-IS in AF and non-AF cohorts, except for obesity in AF patients (adjusted odds ratio: 1.268, 95% confidence interval: 1.023 to 1.572, p = 0.03) in contrast to renal disease, malignancy, and peripheral vascular disease in non-AF patients. In conclusion, IH-IS is a rare complication affecting patients undergoing PCI for AMI and is more likely to occur in AF patients, females, and older adults, with heterogeneity among risk factors in patients with and without AF.
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Affiliation(s)
- Shivaraj Patil
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut.
| | - Karthik Gonuguntla
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
| | - Chaitanya Rojulpote
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Manish Kumar
- Department of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Srinivas Nadadur
- Department of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Robert J Nardino
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
| | - Christopher Pickett
- Department of Cardiology, University of Connecticut, Farmington, Connecticut
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9
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Zhou C, Yu L, Zhu Q, Xiang G, Xv P, Chen C, Cai M, Huang W, Shan P. Clinical outcome of new-onset atrial fibrillation after emergency percutaneous coronary intervention for myocardial infarction. Am J Emerg Med 2020; 45:162-168. [PMID: 33041127 DOI: 10.1016/j.ajem.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/26/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Changzuan Zhou
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China; Department of Cardiology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, PR China
| | - Lingfang Yu
- Department of Nephrology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Qianli Zhu
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Guangze Xiang
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Pengfei Xv
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Chen Chen
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Menxing Cai
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Weijian Huang
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Peiren Shan
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China.
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Altoukhi RM, Alshouimi RA, Al Rammah SM, Alzahrani MY, Almutairi AR, Alshehri AM, Alfayez OM, Al Yami MS, Almohammed OA. Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis. BMJ Open 2020; 10:e036138. [PMID: 32994232 PMCID: PMC7526290 DOI: 10.1136/bmjopen-2019-036138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/13/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Creating an appropriate antithrombotic therapy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) remains a dilemma. Several clinical trials compared the use of a dual antithrombotic therapy (DAT) regimen with a direct oral anticoagulants including (apixaban, dabigatran, edoxaban or rivaroxaban) and a P2Y12 inhibitor versus a triple antithrombotic therapy (TAT) that includes a vitamin K antagonist plus aspirin and a P2Y12 inhibitor in patients with AF who have undergone PCI. However, there are no head-to-head trials comparing the DAT regimens to each other. We aimed to compare the efficacy and safety of DAT regimens using a network meta-analysis (NMA) approach. DESIGN A systematic review and NMA of randomised clinical trials. METHODS We conducted a systematic literature review to identify relevant randomised clinical trials and performed a Bayesian NMA for International Society on Thrombosis and Haemostasis (ISTH) major or clinically relevant non-major (CRNM) bleeding, all-cause mortality, stroke, myocardial infarction (MI) and stent thrombosis outcomes. We used NetMetaXL V.1.6.1 and WinBUGS V.1.4.3 for the NMA and estimated the probability of ranking the treatments based on the surface under the cumulative ranking curve. RESULTS The comparison between DAT regimens showed no significant difference in the safety or efficacy outcomes. Apixaban regimen was ranked first as the preferred therapy in terms of ISTH major or CRNM bleeding and stroke, with a probability of 52% and 54%, respectively. Rivaroxaban regimen was the preferred therapy in terms of MI and stent thrombosis, with a probability of 34% and 27%, respectively. Dabigatran regimen was ranked first in terms of all-cause mortality, with a probability of 28%. CONCLUSION The DAT regimens are as safe and effective as TAT regimens. However, ranking probabilities for the best option in the selected outcomes can be used to guide the selection among these agents based on different patients' conditions.
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Affiliation(s)
- Renad M Altoukhi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reema A Alshouimi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shahad M Al Rammah
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Y Alzahrani
- College of Pharmacy-Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Abdulmajeed M Alshehri
- College of Pharmacy-Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Osamah M Alfayez
- College of Pharmacy-Department of Pharmacy Practice, Qassim University, Buraidah, Saudi Arabia
| | - Majed S Al Yami
- College of Pharmacy-Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omar A Almohammed
- College of Pharmacy-Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
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11
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Impact of Glomerular Filtration Rate on the Incidence and Prognosis of New-Onset Atrial Fibrillation in Acute Myocardial Infarction. J Clin Med 2020; 9:jcm9051396. [PMID: 32397347 PMCID: PMC7291027 DOI: 10.3390/jcm9051396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/07/2023] Open
Abstract
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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12
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Franchina AG, Calderone D, D'Arrigo P, Ingala S, Milluzzo RP, Greco A, Spagnolo M, Tamburino C, Capodanno D. Mechanisms of ST-segment elevation myocardial infarction in patients with atrial fibrillation, prior stenting and long-standing chronic coronary syndrome. Cardiol J 2020; 27:8-15. [PMID: 31960945 DOI: 10.5603/cj.a2020.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/09/2020] [Accepted: 12/12/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The optimal antithrombotic regimen for patients with atrial fibrillation (AF) and chronic coronary syndromes beyond 1 year after percutaneous coronary intervention (PCI) is a matter of debate. For these patients, guidelines recommend oral anticoagulation (OAC) alone, but the risk of thrombotic complications remains a concern. The aim of this study was to characterize the incidence, presentation and use of antithrombotic therapy in patients with AF, prior stenting > 12 months and new ST-segment elevation myocardial infarction (STEMI). METHODS Consecutive patients were selected from an institutional registry over a 3-year period if they matched the following criteria: 1) STEMI undergoing primary PCI; 2) AF; 3) chronic coronary syndrome with prior stenting > 12 months. RESULTS Among 852 consecutive STEMI patients undergoing primary PCI, the prevalence of AF was 4.1%, and 6 (0.9%) patients met all the inclusion criteria. Substantial heterogeneity in antithrombotic treatment for these patients was noted (e.g., OAC alone, OAC plus a single antiplatelet agent, no antithrombotic therapy). In 50% of patients, the STEMI episode was linked to a previously stented lesion or documented plaque. CONCLUSIONS This case review illustrates the wide heterogeneity in antithrombotic pharmacotherapy among AF patients presenting with STEMI > 12 months after PCI. The underlying reason for STEMI is only partly related to disease progression or stent-related events. This finding suggests that multiple mechanisms of recurrence may be advocated, and are not only limited to antithrombotic therapy but may be explained by the natural history of coronary artery disease in remote vessels.
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13
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Morita Y, Hamaguchi T, Yamaji Y, Hayashi H, Nakane E, Haruna Y, Haruna T, Hanyu M, Inoko M. Temporal trends in prevalence and outcomes of atrial fibrillation in patients undergoing percutaneous coronary intervention. Clin Cardiol 2020; 43:33-42. [PMID: 31696533 PMCID: PMC6954373 DOI: 10.1002/clc.23285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in patients undergoing percutaneous coronary intervention (PCI). HYPOTHESIS Large administrative data may provide further insight into temporal trends in the prevalence and burden of AF in patients who underwent PCI. METHODS Using the National Inpatient Sample database in the U.S., AF patients ≥18 years who underwent PCI between 2005 and 2014 and were identified by the International Classification of Diseases, ninth revision, Clinical Modification, were examined. In-hospital mortality, morbidity, resource use, and medical costs were evaluated in crude and propensity-matched analyses. RESULTS Among an estimated 6 272 232 hospitalizations, of patients undergoing PCI, AF prevalence was 9.9% and steadily increased from 8.6% to 12.0% between 2005 and 2014 (P < .001); there was also a greater proportion of comorbidities. There was a marked increase in AF prevalence among those aged ≥65 years and those undergoing elective PCIs. AF was independently associated with higher in-hospital mortality and higher rates of transient ischaemic attack/stroke, bleeding complications, and non-home discharge. Excessive in-hospital mortality, stroke rate, gastrointestinal bleeding, blood transfusion, length of stay, and costs among AF hospitalizations were consistently observed throughout the study period. CONCLUSION AF becomes more prevalent in patients undergoing PCI, possibly due to a higher comorbidity, particularly in elderly patients with non-acute indications. Less favorable trends in mortality, bleeding, and stroke among AF patients who underwent PCI were consistent over time. Continuous efforts are needed to improve outcomes and manage strategies for AF patients undergoing PCI.
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Affiliation(s)
- Yusuke Morita
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Toka Hamaguchi
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Yuhei Yamaji
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Hideyuki Hayashi
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Eisaku Nakane
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Yoshisumi Haruna
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Tetsuya Haruna
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Michiya Hanyu
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
| | - Moriaki Inoko
- Cardiovascular Center, Tazuke Kofukai FoundationMedical Research Institute, Kitano HospitalOsakaJapan
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14
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Mohamed MO, Kirchhof P, Vidovich M, Savage M, Rashid M, Kwok CS, Thomas M, El Omar O, Al Ayoubi F, Fischman DL, Mamas MA. Effect of Concomitant Atrial Fibrillation on In-Hospital Outcomes of Non-ST-Elevation-Acute Coronary Syndrome-Related Hospitalizations in the United States. Am J Cardiol 2019; 124:465-475. [PMID: 31248589 DOI: 10.1016/j.amjcard.2019.05.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in patients presenting with acute coronary syndrome (ACS). The present study examined the rates and trends of clinical outcomes and management strategies of non-ST-elevation ACS (NSTE-ACS) related hospitalizations in the United States, in patients with concomitant AF compared with those in sinus rhythm (SR). We analyzed the "Nationwide Inpatient Sample" database (2004 to 2014) for patients with a primary discharge diagnosis of NSTE-ACS, and further stratified the cohort on the basis of diagnoses into SR and AF groups. Multivariate analysis was performed to examine the association between AF and major adverse cardiovascular and cerebrovascular events (composite of mortality, stroke, and cardiac complications) and its components. Of 4,668,737 NSTE-ACS hospitalizations, the proportions of SR and AF groups were 82.4% (3,848,202) and 17.6% (820,535), respectively. The incidence of AF increased significantly over time from 16.5% (2004) to 19.3% (2014). The AF group was at a greater risk of adverse outcomes with higher rates and adjusted relative risk (RR) of major adverse cardiovascular and cerebrovascular events (12.9% vs 5.3%; RR 1.74 [1.72, 1.75]), mortality (6.5% vs 3.3%; RR 1.12 [1.11, 1.13]), stroke (2.7% vs 1.5%; RR 1.32 [1.30, 1.34]), and bleeding (14.7% vs 8.8%; RR 1.42 [1.41, 1.43]). Furthermore, the AF group was less likely to receive coronary angiography (47.1% vs 58%) and percutaneous coronary intervention (18.7% vs 32.6%) in comparison to SR (p <0.001 for all outcomes). In conclusion, patients with concomitant AF and NSTE-ACS are less likely to be offered an invasive management strategy for their ACS and are associated with worse complications and higher mortality.
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Affiliation(s)
- Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Newcastle, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mladen Vidovich
- Department of Cardiology, University of Illinois, Chicago, Illinois
| | - Michael Savage
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Newcastle, United Kingdom
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Newcastle, United Kingdom
| | - Mark Thomas
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Omar El Omar
- Manchester Medical School, University of Manchester, Manchester, United Kingdom
| | - Fakhr Al Ayoubi
- Department of Cardiac Sciences, KFCC, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - David L Fischman
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mamas Andreas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Newcastle, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom.
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15
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Shiyovich A, Axelrod M, Gilutz H, Plakht Y. Early Versus Late New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Differences in Clinical Characteristics and Predictors. Angiology 2019; 70:921-928. [DOI: 10.1177/0003319719867542] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out “high risk” AMI population for more meticulous heart rate monitoring for NOAF.
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Affiliation(s)
- Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and “Sackler” Faculty of Medicine, Tel-Aviv University Israel, Tel Aviv-Yafo, Israel
| | - Michal Axelrod
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Harel Gilutz
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ygal Plakht
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, and Soroka University Medical Center, Beer-Sheva, Israel
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16
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Yildirim E, Ermis E, Allahverdiyev S, Ucar H, Cengiz M. Value of Syntax Score II in Prediction of New-Onset Atrial Fibrillation in Patients With NSTE-ACS Undergoing Percutaneous Coronary Intervention. Angiology 2019; 70:860-866. [DOI: 10.1177/0003319719854242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
New-onset atrial fibrillation (NOAF) has been associated with poor outcome in patients with acute coronary syndromes (ACSs). The objective of this study was to investigate the relationship between the development of NOAF and severity of coronary artery disease using the SYNTAX score (SS) and SYNTAX score II (SSII) in patients with non-ST-segment elevation ACS (NSTE-ACS) who were treated with percutaneous coronary intervention (PCI). A total of 662 patients with NSTE-ACS were consecutively enrolled. The incidence of NOAF was 11.4% among the patients with NSTE-ACS. Mean age was significantly higher in NOAF group ( P = .011). White blood cell count, peak troponin I, high sensitivity C-reactive protein, uric acid, left atrial volume index, and ratio between early mitral inflow velocity and mitral annular early diastolic velocity were significantly higher in NOAF group (respectively, P = .024, P = .017, P = .002, P = .009, P = .025, P < .001, and P < .001). The hemoglobin, ejection fraction, and post PCI thrombolysis in myocardial infarction grade <3 were significantly lower in NOAF group ( P = 001, P = .010, P = .038). The SS and SSII were significantly higher in NOAF group (all P < .001). According to the results of multivariate logistic regression analysis, the SSII was correlated with NOAF ( P < .001) in the study groups. We demonstrated that high SSII is significantly associated with NOAF.
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Affiliation(s)
- Erkan Yildirim
- Department of Cardiology, Biruni University Faculty of Medicine, İstanbul, Turkey
| | - Emrah Ermis
- Department of Cardiology, Biruni University Faculty of Medicine, İstanbul, Turkey
| | - Samir Allahverdiyev
- Department of Cardiology, Biruni University Faculty of Medicine, İstanbul, Turkey
| | - Hakan Ucar
- Department of Cardiology, Biruni University Faculty of Medicine, İstanbul, Turkey
| | - Mahir Cengiz
- Department of Internal Medicine, Biruni University Faculty of Medicine, İstanbul, Turkey
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17
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Hariri E, Lessard D, Gore J, Rade J, Goldberg R. Are We Optimizing the Use of Dual Antiplatelet Therapy in Patients Hospitalized with Acute Myocardial Infarction? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:182-188. [PMID: 31129036 DOI: 10.1016/j.carrev.2019.04.024] [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: 03/06/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) is a mainstay treatment for hospital survivors of an acute myocardial infarction (AMI). However, there are limited data on the prescribing patterns of DAPT among patients hospitalized with AMI during recent years. OBJECTIVE To examine decade-long trends (2001-2011) in the use of DAPT versus antiplatelet monotherapy and patient characteristics associated with DAPT use. METHODS The study population consisted of 2389 adults hospitalized with an initial AMI at all 11 central Massachusetts medical centers on a biennial basis between 2001 and 2011. DAPT was defined as the discharge use of aspirin plus either clopidogrel or prasugrel. Logistic regression analysis was used to identify patient characteristics associated with DAPT use. RESULTS The average age of the study population was 65 years, and 69% of patients were discharged on DAPT. The use of DAPT at the time of hospital discharge increased from 49% in 2001 to 74% in 2011; this increasing trend was seen across all age groups, both sexes, types of AMI, and in those who underwent a PCI. After multivariable adjustment, patients 65-74 years old (adjusted odds ratio (aOR) = 0.53, 95% CI: 0.36-0.80) and those who underwent coronary artery bypass surgery (aOR = 0.11, 95% CI: 0.07-0.18) were less likely to have received DAPT, while men (aOR = 14.60, 95% CI: 10.66-19.98) and those who underwent cardiac catheterization and stenting (aOR = 14.60, 95% CI: 10.66-19.98) were significantly more likely to have received DAPT at discharge than respective comparison groups. CONCLUSIONS Between 2001 and 2011, the use of DAPT increased markedly among patients hospitalized with AMI. However, a significant proportion of patients were not discharged on this therapy. Greater awareness is needed to incorporate DAPT into the management of patients hospitalized with AMI.
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Affiliation(s)
- Essa Hariri
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Joel Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Jeffrey Rade
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America.
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18
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Fluschnik N, Becher PM, Schnabel R, Blankenberg S, Westermann D. Anticoagulation strategies in patients with atrial fibrillation after PCI or with ACS : The end of triple therapy? Herz 2019; 43:20-25. [PMID: 29188358 DOI: 10.1007/s00059-017-4649-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinicians struggle daily with the optimal regimen for patients with an indication for antiplatelet therapy after stenting and in patients needing oral anticoagulation treatment for atrial fibrillation (AF). This is not only difficult in patients with acute coronary syndrome (ACS) but also in the large number of patients with AF undergoing elective percutaneous coronary intervention (PCI). The challenge is to strike a balance between the increasing risk of bleeding events and ischemic or thrombotic events. Until recently, guidelines were based on expert consensus and a few small, many of them retrospective, trials. A so-called triple therapy with a vitamin K antagonist (VKA) and dual antiplatelet therapy (DAPT) with aspirin and clopidogrel was recommended for patients with AF undergoing PCI in stable coronary artery disease or for those with ACS. However, severe bleeding complications remain a major issue during triple therapy, particularly in the growing aging population. In the past year, randomized controlled trials (RCT) with direct-acting oral anticoagulants (DOACs) have modified the standard use of care, now favoring dual therapy with DOACs. This review elucidates the current influential RCTs on the new antiplatelet and anticoagulation strategies for patients with AF undergoing PCI or with ACS, and discusses whether triple therapy is still required.
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Affiliation(s)
- N Fluschnik
- Department of General and Interventional Cardiology, University Heart Center, Martinistr. 52, Hamburg Eppendorf, Germany.,DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
| | - P M Becher
- Department of General and Interventional Cardiology, University Heart Center, Martinistr. 52, Hamburg Eppendorf, Germany
| | - R Schnabel
- Department of General and Interventional Cardiology, University Heart Center, Martinistr. 52, Hamburg Eppendorf, Germany.,DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
| | - S Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Martinistr. 52, Hamburg Eppendorf, Germany.,DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
| | - D Westermann
- Department of General and Interventional Cardiology, University Heart Center, Martinistr. 52, Hamburg Eppendorf, Germany. .,DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany.
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19
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Kaya A, Keskin M, Tatlisu MA, Uzman O, Borklu E, Cinier G, Yildirim E, Kayapinar O. Atrial Fibrillation: A Novel Risk Factor for No-Reflow Following Primary Percutaneous Coronary Intervention. Angiology 2019; 71:175-182. [DOI: 10.1177/0003319719840589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is a lack of evidence regarding the association of atrial fibrillation (AF) and no-reflow (NR) phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). A total of 2452 patients with STEMI who underwent pPCI were retrospectively investigated. After exclusions, 370 (14.6%) patients were in the AF group and 2095 (85.4%) were in the No-AF group. Patients with a thrombolysis in myocardial infarction flow rate <3 were defined as having NR. Patients in the AF group were older and had higher 3-vessel disease rates (24.1% vs 18.9%; P = .021) and lower left ventricular ejection fraction (45.4 [11.7] vs 48.7 [10.5%]; P < .001). No-reflow rates were higher in the AF group than in the No-AF group (29.1% vs 11.8%; P < .001). According to multivariable analysis, AF (odds ratio: 1.81, 95% confidence interval: 1.63-2.04, P < .001), age, Killip class, anterior myocardial infarction, diabetes mellitus, chronic kidney disease, stent length, and smoking were independent predictors of NR following pPCI. Atrial fibrillation is a quite common arrhythmia in patients with STEMI. Atrial fibrillation was found to be an independent predictor of NR in the current study. This effect of AF on coronary flow rate might be considered as an important risk factor in STEMI.
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Affiliation(s)
- Adnan Kaya
- Cardiology, Duzce University School of Medicine, Duzce, Turkey
| | - Muhammed Keskin
- Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | | | - Osman Uzman
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Edibe Borklu
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Goksel Cinier
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Ersin Yildirim
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Osman Kayapinar
- Cardiology, Duzce University School of Medicine, Duzce, Turkey
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20
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Nagai M, Itoh T, Ishida M, Fusazaki T, Komatsu T, Nakamura M, Morino Y. New-onset atrial fibrillation in patients with acute coronary syndrome may be associated with worse prognosis and future heart failure. J Arrhythm 2019; 35:182-189. [PMID: 31007781 PMCID: PMC6457477 DOI: 10.1002/joa3.12154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/09/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic value of atrial fibrillation (AF) in patients with acute coronary syndrome (ACS). METHODS A total 648 of consecutive ACS patients were divided into non-AF and all-AF groups. The all-AF group was further subdivided into new-onset AF and pre-existing AF groups. We compared prognosis among these groups using the Cox regression analysis. RESULTS The mean follow-up period was 1.4 ± 1.2 years. Overall patient numbers were 538 in non-AF and 110 in all-AF groups (67 in new-onset AF and 43 in pre-existing AF). Seventy-eight all-cause deaths and 42 cardiac deaths were observed. New-onset AF had a worse prognosis than the other groups in the Kaplan-Meier analysis (P = 0.025) after observation. Cox regression analysis indicated no significant difference for all-cause death among the three groups. The hazard ratio of congestive heart failure requiring hospitalization was significantly higher in the all-AF and new-onset AF group than in the non-AF group. Multivariate logistic regression analysis revealed that renal dysfunction, peripheral arterial disease, Killip classification ≥2, and left ventricular ejection fraction (LVEF) were independent predictors of all-cause death. The new-onset AF group had the highest prevalence of Killip classification ≥2 and the lowest LVEF. CONCLUSION In our study, AF was not an independent predictor of all-cause death, but new-onset AF may be associated with worse prognosis and future heart failure.
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Affiliation(s)
- Mizuyoshi Nagai
- Division of CardiologyDepartment of Internal MedicineMemorial Heart CenterIwate Medical UniversityMoriokaIwateJapan
| | - Tomonori Itoh
- Division of CardiologyDepartment of Internal MedicineMemorial Heart CenterIwate Medical UniversityMoriokaIwateJapan
| | - Masaru Ishida
- Division of CardiologyDepartment of Internal MedicineMemorial Heart CenterIwate Medical UniversityMoriokaIwateJapan
| | - Tetsuya Fusazaki
- Division of CardiologyDepartment of Internal MedicineMemorial Heart CenterIwate Medical UniversityMoriokaIwateJapan
| | - Takashi Komatsu
- Division of CardiologyDepartment of Internal MedicineMemorial Heart CenterIwate Medical UniversityMoriokaIwateJapan
| | - Motoyuki Nakamura
- Division of CardiologyDepartment of Internal MedicineMemorial Heart CenterIwate Medical UniversityMoriokaIwateJapan
| | - Yoshihiro Morino
- Division of CardiologyDepartment of Internal MedicineMemorial Heart CenterIwate Medical UniversityMoriokaIwateJapan
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21
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Goldberg RJ, Tisminetzky M, Tran HV, Yarzebski J, Lessard D, Gore JM. Decade Long Trends (2001-2011) in the Incidence Rates of Initial Acute Myocardial Infarction. Am J Cardiol 2019; 123:206-211. [PMID: 30409411 DOI: 10.1016/j.amjcard.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022]
Abstract
Despite the magnitude and impact of acute coronary disease, there are limited population-based data in the United States describing relatively recent trends in the incidence rates of acute myocardial infarction (AMI). The objectives of this study were to describe decade long (2001-2011) trends in the incidence rates of initial hospitalized episodes of AMI, with further stratification of these rates by age, sex, and type of AMI, in residents of central Massachusetts hospitalized at 11 area medical centers. The study population consisted of 3,737 adults hospitalized with a first AMI at 11 medical centers in central Massachusetts on a biennial basis between 2001 and 2011. The median age of this study population was 70 years, 57% were men, and 90% were white. Patients hospitalized during the most recent study years (2009/11) were younger, more likely to be men, have more co-morbidities, and less in-hospital complications as compared with those in the earliest study years (2001/03). The overall age-adjusted hospital incidence rates (per 100,000 persons) of initial AMI declined (from 319 to 163), for men (from 422 to 219), women (from 232 to 120), for patients with a ST segment elevation (129 to 56), and for those with an non-ST segment elevation (190 to 107) between 2001 and 2011, respectively. In conclusion, the incidence rates of initial AMI declined appreciably in residents of central Massachusetts who were hospitalized with AMI during the years under study.
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Affiliation(s)
- Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Meyers Primary Care Institute and the Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hoang V Tran
- Department of Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel M Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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22
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Cirakoglu OF, Aslan AO, Akyuz AR, Kul S, Şahin S, Korkmaz L, Sayın MR. The value of syntax score to predict new-onset atrial fibrillation in patients with acute coronary syndrome. Ann Noninvasive Electrocardiol 2019; 24:e12622. [PMID: 30615236 DOI: 10.1111/anec.12622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/04/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIM New-onset atrial fibrillation (NOAF) has been associated with poor outcome in patients with acute coronary syndromes (ACS). Also, Syntax score (SS) is a scoring system that is derived from angiographic images and is associated with long-term mortality and major adverse cardiac events. In this study, we aimed to assess the relationship between SS and NOAF with known predictors of atrial fibrillation. METHODS In a prospective, single-center, cross-sectional study, 692 patients who were diagnosed with coronary artery disease for the first time were enrolled consecutively. NOAF was defined as atrial fibrillation, which was documented after hospital admission. SS was calculated by a computer software. Multivariable logistic regression analyzes were used to detect the relationship between variables and NOAF. RESULTS New-onset atrial fibrillation was detected in 82 patients (11.8%). Patients with NOAF had higher SS (22, interquartile range 18.3-25.1, vs. 12, interquartile range 7-19.5, p < 0.001). According to multivariable logistic regression analysis for NOAF, SS were independently and significantly associated (OR, 1.103; 95% confidence interval, 1.047-1.163; p < 0.001). Other independent predictors of NOAF were TIMI flow <3, C reactive protein, left ventricular ejection fraction, left atrial volume index and E/E' ratio. The optimal cut-off value for SS was 18 for the development of NOAF with 82% sensitivity and 68% specificity (area under the curve: 0.795, 95% confidence interval 0.749-0.841, p < 0.001). CONCLUSION Syntax score may be helpful to identify for patients who would develop atrial fibrillation in the setting of ACS.
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Affiliation(s)
- Omer Faruk Cirakoglu
- Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Ahmet Oğuz Aslan
- Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey.,Department of Cardiology, Akçaabat Haçkalı Baba State Hospital, Trabzon, Turkey
| | - Ali Riza Akyuz
- Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Selim Kul
- Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Sinan Şahin
- Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Levent Korkmaz
- Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Muhammet Raşit Sayın
- Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
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23
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Galjautdinov1 GS, Gorelkin IV, Ibragimova KR, Sadriev RR. NEW-ONSET ATRIAL FIBRILLATION IN SETTINGS OF ACUTE CORONARY SYNDROME. CURRENT ISSUES. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-3-451-457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present review is focuses on new onset atrial fibrillation (AF) in conditions of acute coronary syndrome (ACS). Literature sources from PubMed and Scopus was used. AF is common in the general population and in the ACS population, at that new onset AF, and AF, which was by the time of ACS development are determined. Appearance of AF is more likely amongst the elderly patients with congestive heart failure, with signs of the hemodynamic instability and with the left atrium dilatation. It is well-known about the predictors of adverse outcome in ACS. According to some literature data new onset AF leads to worsening of prognosis, and in line with other sources a reason of its association with high level of mortality is due to the severity of ACS and appearance of AF is not independent predictor of death. The absence of subjective symptoms at the time of paroxysm of new onset AF does not allow estimating its duration and distinguishing between the new onset AF, persistent and constant AF. It is possible to trace the relationship between the myocardial ischemia and AF appearance. Inefficient reperfusion during percutaneous coronary intervention or thrombolytic therapy is accompanied by the onset of AF, on the contrary, when effective patency of coronary artery is achieved, AF appears significantly less often. New onset AF in ACS, in particular, accompanied by cardiogenic shock, requires emergency pharmacological or electrical cardioversion. In some cases, active cardioversion is not necessary, because of spontaneous cardiac rhythm conversion. In conclusions, it is necessary to point out, that ambiguity and multifactority of this problem demands investigation of arrhythmogenesis mechanisms and development of special risk stratification instruments for the new onset AF in ACS.
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24
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Bourezg A, Bochaton T, Mewton N, Morel O, Cayla G, Rioufol G, Bonnefoy-Cudraz E, Guerin P, Elbaz M, Boussaha I, Amaz C, Angoulvant D, Ovize M. Atrial fibrillation, intra-ventricular thrombus, and other anticoagulant indications relationship with adverse outcomes in acute anterior myocardial infarction patients. J Cardiol 2018; 72:277-283. [PMID: 29753538 DOI: 10.1016/j.jjcc.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to assess the predictive value of atrial fibrillation (AF), left ventricular thrombus (LVT), and other oral anticoagulant (OAC) indications on 1-year major adverse cardio-cerebrovascular events (MACCE) and bleeding in acute anterior ST-elevated myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). METHODS Our study population included 969 anterior STEMI patients referred for PPCI from the prospective multicenter CIRCUS trial. Patients with a formal indication of OAC within the first year were compared to those without indication. RESULTS A total of 161 (16.6%) patients were eligible for OAC after anterior STEMI mainly for AF (51.5%) and LVT (39.7%). This group had a higher morbidity profile despite similar reperfusion settings - 67% of them were treated with OAC. At 1 year, OAC indication was associated with a significant increase in MACCE rate [OR 3.37 95% CI (2.36;4.82) p<0.001] as well as bleeding [OR=1.96 95% CI (1.09;3.50) p=0.02]. After adjustment for principal confounders, OAC indication remained strongly associated with MACCE [HR 3.40 (1.26;9.14) p=0.016]. CONCLUSIONS In a prospective cohort of anterior STEMI, AF, LVT, and other OAC indications were present upon discharge in 1 patient out of 6 and only two thirds were treated with OAC. OAC indication was independently associated with an increased risk of MACCE and bleeding at one year.
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Affiliation(s)
- Asma Bourezg
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel, Clinical Investigation Center, Inserm 1407, Hospices Civils de Lyon, Bron, France.
| | - Olivier Morel
- Centre Hospitalier Universitaire de Strasbourg, Coronary Care Unit, Strasbourg, France
| | - Guillaume Cayla
- Centre Hospitalier Universitaire de Nîmes, Coronary Care Unit, Nîmes, France
| | - Gilles Rioufol
- Hôpital Cardiovasculaire Louis Pradel, Interventional Cardiology Department, Hospices Civils de Lyon, Bron, France
| | - Eric Bonnefoy-Cudraz
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
| | - Patrice Guerin
- Hôpital Laennec, Centre Hospitalier Universitaire de Nantes, Interventional Cardiology Department, Nantes, France
| | - Meyer Elbaz
- Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Interventional Cardiology Department, Toulouse, France
| | - Inesse Boussaha
- Hôpital Cardiovasculaire Louis Pradel, Clinical Investigation Center, Inserm 1407, Hospices Civils de Lyon, Bron, France
| | - Camille Amaz
- Hôpital Cardiovasculaire Louis Pradel, Clinical Investigation Center, Inserm 1407, Hospices Civils de Lyon, Bron, France
| | - Denis Angoulvant
- Hôpital Trousseau, Centre Hospitalier Regional de Tours, Intensive Care Unit, Tours, France
| | - Michel Ovize
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
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25
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Ćatić J, Jurin I, Lucijanić M, Jerkić H, Blažeković R. High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting diastolic than systolic left ventricular dysfunction: A single-center prospective cohort study. Medicine (Baltimore) 2018; 97:e0601. [PMID: 29718862 PMCID: PMC6393031 DOI: 10.1097/md.0000000000010601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Multiple studies have demonstrated the association of red cell distribution width (RDW) with the ultrasound parameters of both systolic and diastolic heart dysfunction. We aimed to further investigate the clinical associations of RDW in the setting of ST-elevation myocardial infarction (STEMI) and to comparatively evaluate its predictive properties regarding systolic and diastolic dysfunction.A total of 89 patients with STEMI were prospectively analyzed. RDW was obtained at the time of STEMI and compared to the parameters of systolic and diastolic dysfunction obtained by transthoracic heart ultrasound on the 5th through 7th day post-STEMI.The median RDW was 13.9%, and among other factors, RDW was significantly associated with older age (P < .001), arterial hypertension (P = .017), hyperlipoproteinemia 2, nonsmoking (P = .027), increased thrombolysis in myocardial infarction score (P = .004), and multivessel disease (P = .007). A higher RDW was observed in patients with parameters that indicated systolic and diastolic dysfunction (ejection fraction of the left ventricle < 50% [P = .009], early/late diastolic filling wave ratio [E/A] < 1 [P = .001], ratio of peak early transmitral velocity and early diastolic annular velocity [E/E'] >10 [P < .001], and combined E/A < 1 and E/E' > 10 [P < .001]). The best discriminatory properties were observed for combined E/A < 1 and E/E' > 10. RDW remained significantly associated with the aforementioned parameters in a series of multivariate regression models.Elevated RDW is significantly associated with the parameters of systolic and diastolic dysfunction even after adjusting for several confounding factors in the setting of STEMI and subsequent percutaneous coronary intervention. RDW seems to be better at discriminating patients with diastolic rather than systolic dysfunction.
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Affiliation(s)
- Jasmina Ćatić
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
| | - Ivana Jurin
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
| | | | - Helena Jerkić
- Department of Cardiology, Clinical Hospital “Merkur”
| | - Robert Blažeković
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
- Department of Cardiac and Transplant Surgery, Clinical Hospital “Dubrava”, Zagreb, Croatia
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26
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Kundu A, Day KO, Lessard DM, Gore JM, Lubitz SA, Yu H, Akhter MW, Fisher DZ, Hayward RM, Henninger N, Saczynski JS, Walkey AJ, Kapoor A, Yarzebski J, Goldberg RJ, McManus DD. Recent Trends in Oral Anticoagulant Use and Post-Discharge Complications Among Atrial Fibrillation Patients with Acute Myocardial Infarction. J Atr Fibrillation 2018; 10:1749. [PMID: 29988239 PMCID: PMC6006973 DOI: 10.4022/jafib.1749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/23/2018] [Accepted: 02/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI).The CHA2DS2VAScand CHADS2risk scoresare used to identifypatients with AF at risk for strokeand to guide oral anticoagulants (OAC) use, including patients with AMI. However, the epidemiology of AF, further stratifiedaccording to patients' risk of stroke, has not been wellcharacterized among those hospitalized for AMI. METHODS We examined trends in the frequency of AF, rates of discharge OAC use, and post-discharge outcomes among 6,627 residents of the Worcester, Massachusetts area who survived hospitalization for AMI at 11 medical centers between 1997 and 2011. RESULTS A total of 1,050AMI patients had AF (16%) andthe majority (91%)had a CHA2DS2VAScscore >2.AF rates were highest among patients in the highest stroke risk group.In comparison to patients without AF, patients with AMI and AF in the highest stroke risk category had higher rates of post-discharge complications, including higher 30-day re-hospitalization [27 % vs. 17 %], 30-day post-discharge death [10 % vs. 5%], and 1-year post-discharge death [46 % vs. 18 %] (p < 0.001 for all). Notably, fewerthan half of guideline-eligible AF patientsreceived an OACprescription at discharge. Usage rates for other evidence-based therapiessuch as statins and beta-blockers,lagged in comparison to AMI patients free from AF. CONCLUSIONS Our findings highlight the need to enhance efforts towards stroke prevention among AMI survivors with AF.
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Affiliation(s)
- Amartya Kundu
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kevin O Day
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen M Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Steven A Lubitz
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Hong Yu
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mohammed W Akhter
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel Z Fisher
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert M Hayward
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, USA
| | - Allan J Walkey
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Alok Kapoor
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
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27
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Yamada S, Fong MC, Hsiao YW, Chang SL, Tsai YN, Lo LW, Chao TF, Lin YJ, Hu YF, Chung FP, Liao JN, Chang YT, Li HY, Higa S, Chen SA. Impact of Renal Denervation on Atrial Arrhythmogenic Substrate in Ischemic Model of Heart Failure. J Am Heart Assoc 2018; 7:JAHA.117.007312. [PMID: 29358197 PMCID: PMC5850156 DOI: 10.1161/jaha.117.007312] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Myocardial infarction increases the risk of heart failure (HF) and atrial fibrillation. Renal denervation (RDN) might suppress the development of atrial remodeling. This study aimed to elucidate the molecular mechanism of RDN in the suppression of atrial fibrillation in a HF model after myocardial infarction. METHODS AND RESULTS HF rabbits were created 4 weeks after coronary ligation. Rabbits were classified into 3 groups: normal control (n=10), HF (n=10), and HF-RDN (n=6). Surgical and chemical RDN were approached through midabdominal incisions in HF-RDN. Left anterior descending coronary artery in HF and HF-RDN was ligated to create myocardial infarction. After electrophysiological study, the rabbits were euthanized and the left atrial appendage was harvested for real-time polymerase chain reaction analysis and Trichrome stain. Left atrial dimension and left ventricular mass were smaller in HF-RDN by echocardiography compared with HF. Attenuated atrial fibrosis and tyrosine hydroxylase levels were observed in HF-RDN compared with HF. The mRNA expressions of Cav1.2, Nav1.5, Kir2.1, KvLQT1, phosphoinositide 3-kinase, AKT, and endothelial nitric oxide synthase in HF-RDN were significantly higher compared with HF. The effective refractory period and action potential duration of HF-RDN were significantly shorter compared with HF. Decreased atrial fibrillation inducibility was noted in HF-RDN compared with HF (50% versus 100%, P<0.05). CONCLUSIONS RDN reversed atrial electrical and structural remodeling, and suppressed the atrial fibrillation inducibility in an ischemic HF model. The beneficial effect of RDN may be related to prevention of the downregulation of the phosphoinositide 3-kinase/AKT/endothelial nitric oxide synthase signaling pathway.
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Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Man-Cai Fong
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Wen Hsiao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan .,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Nan Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Hsing-Yuan Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Satoshi Higa
- Division of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Laboratory, Makiminato Central Hospital, Okinawa, Japan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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28
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Podolecki T, Lenarczyk R, Kowalczyk J, Jedrzejczyk-Patej E, Swiatkowski A, Chodor P, Sedkowska A, Streb W, Mitrega K, Kalarus Z. Significance of Atrial Fibrillation Complicating ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017. [PMID: 28645470 DOI: 10.1016/j.amjcard.2017.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of the present study is to assess the clinical impact of atrial fibrillation (AF) in patients with ST-segment elevation myocardial infarction (STEMI) complicated by new-onset AF depending on STEMI location and timing of arrhythmia. We analyzed 4,363 consecutive STEMI patients treated invasively. Finally, 4,099 subjects were included into further analysis, as 264 patients were excluded because of previous AF history. In total, 1,800 (43.9%) subjects with anterior infarction were included into Group 1, whereas Group 2 encompassed 2,299 (56.1%) patients with nonanterior infarction. Subsequently, both groups were divided into patients with new-onset AF (AF Group 1 and 2, respectively) and without AF (Control Group 1 and 2). New-onset AF was recognized in 225 patients (5.5%): 96 (5.3%) with an anterior wall infarction (AF Group 1) and 129 (5.6%) with a nonanterior wall infarction (AF Group 2). The incidence of early-onset arrhythmia (within 24 hours after admission) was significantly higher in AF Group 2 than in AF Group 1: 71.3% versus 35.4% (p <0.001). In Group 1, both early- and late-onset AFs were associated with significantly increased in-hospital mortality compared with AF-free population (17.7% and 27.4%, respectively vs 6.3%; p <0.05), whereas in Group 2, in-hospital mortality was increased only in subjects with late-onset AF compared with AF-free population (13.5% vs 4.2%, p <0.05). New-onset AF was the independent predictor of death only in Group 1 (hazard ratio 2.16) and this effect was stronger for late-onset AF (hazard ratio 2.86). In conclusion, 1 in 20 patients with STEMI treated invasively was affected by new-onset AF. The predictive value of new-onset AF was strongly related with STEMI location and timing of arrhythmia.
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29
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Outcomes of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol 2017; 68:895-904. [PMID: 27561762 DOI: 10.1016/j.jacc.2016.05.085] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 04/26/2016] [Accepted: 05/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is increasing in prevalence, and patients with a history of AF commonly undergo percutaneous coronary intervention (PCI). There is a paucity of contemporary data on the association between AF and clinical outcomes after PCI. OBJECTIVES The study sought to evaluate the association between AF and in-hospital adverse outcomes using a large, prospective multicenter registry. METHODS Data for consecutive PCI cases from 47 hospitals performed between April 2011 and December 2014 were utilized for the analysis. Propensity-matched multivariate analysis was used to adjust for differences in baseline characteristics between patients with and without a history of AF. RESULTS Of 113,283 PCI cases during the study period, a history of AF was present in 13,912 patients (12%), which varied by institution (range 2.5% to 18.4%). At baseline, patients with a history of AF were older and were more likely to have comorbid congestive heart failure, cardiomyopathy, cerebrovascular disease, and chronic lung disease. Patients with a history of AF were more likely to have in-hospital complications, including in-hospital mortality (3% vs. 1%). In propensity-matched analysis, patients with a history of AF were more likely to be treated with a bare-metal stent (27% vs. 18%). In the propensity-matched model, AF remained independently associated with an increased risk of developing post-procedural bleeding (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.15 to 1.52), heart failure (OR: 1.33; 95% CI: 1.17 to 1.52), cardiogenic shock (OR: 1.26; 95% CI: 1.08 to 1.48), and in-hospital mortality (OR: 1.41; 95% CI: 1.18 to 1.68). CONCLUSIONS AF is common among patients undergoing PCI. AF is associated with older age, the presence of other comorbidities, and independently associated with in-hospital post-procedural heart failure, cardiogenic shock, and mortality.
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Trends in the Magnitude of, and Patient Characteristics Associated With, Multiple Hospital Readmissions After Acute Myocardial Infarction. Am J Cardiol 2016; 118:1117-1122. [PMID: 27639688 DOI: 10.1016/j.amjcard.2016.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 11/20/2022]
Abstract
There are limited contemporary data available describing recent trends in the magnitude and characteristics of patients who are rehospitalized multiple times after hospital discharge for an acute myocardial infarction (AMI). We reviewed the medical records of 4,480 residents of the Worcester, Massachusetts, metropolitan area, who were discharged from 3 Central Massachusetts medical centers after an AMI in 6 biennial periods from 2001 to 2011 and were followed for all-cause and cause-specific hospital readmissions over the subsequent 6 months. The average age of our study population was 68 years, 89% were white, and 41% were women. Overall, ∼1 of every 3 patients had a readmission to the hospital within 6 months after hospital discharge for an AMI. The proportion of patients who were readmitted to the hospital 1, 2, or 3 times for any cause within 6 months remained unchanged during the years under study (20%, 8%, and 6%, respectively); 59% of these readmissions were cardiac related. Women, elderly patients, those with multiple chronic conditions, patients with a prolonged index hospitalization, and those who developed heart failure and/or atrial fibrillation during hospitalization were at higher risk for being readmitted multiple times compared with those who were readmitted once. Six-month hospital readmission rates after hospital discharge for an AMI remained stable during the years under study. In conclusion, we identified several groups at higher risk for multiple hospital readmissions who might be targeted for intensified monitoring efforts and tailored educational and treatment approaches.
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Kundu A, O'Day K, Shaikh AY, Lessard DM, Saczynski JS, Yarzebski J, Darling CE, Thabet R, Akhter MW, Floyd KC, Goldberg RJ, McManus DD. Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission. Am J Cardiol 2016; 117:1213-8. [PMID: 26874548 DOI: 10.1016/j.amjcard.2016.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 02/05/2023]
Abstract
Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and contributes to high rates of in-hospital adverse events. However, there are few contemporary studies examining rates of AF in the contemporary era of AMI or the impact of new-onset AF on key in-hospital and postdischarge outcomes. We examined trends in AF in 6,384 residents of Worcester, Massachusetts, who were hospitalized with confirmed AMI during 7 biennial periods between 1999 and 2011. Multivariate logistic regression analysis was used to examine associations between occurrence of AF and various in-hospital and postdischarge complications. The overall incidence of AF complicating AMI was 10.8%. Rates of new-onset AF increased from 1999 to 2003 (9.8% to 13.2%), and decreased thereafter. In multivariable adjusted models, patients developing new-onset AF after AMI were at a higher risk for in-hospital stroke (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.6 to 4.1), heart failure (OR 2.0, 95% CI 1.7 to 2.4), cardiogenic shock (OR 3.7, 95% CI 2.8 to 4.9), and death (OR 2.3, 95% CI 1.9 to 3.0) than patients without AF. Development of AF during hospitalization for AMI was associated with higher rates of readmission within 30 days after discharge (21.7% vs 16.0%), but no significant difference was noted in early postdischarge 30-day all-cause mortality rates (8.3% vs 5.1%). In conclusion, new-onset AF after AMI is strongly related to in-hospital complications of AMI and higher short-term readmission rates.
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Awad HH, Tisminetzky M, Metry D, McManus D, Yarzebski J, Gore JM, Goldberg RJ. Magnitude, treatment, and impact of diabetes mellitus in patients hospitalized with non-ST segment elevation myocardial infarction: A community-based study. Diab Vasc Dis Res 2016; 13:13-20. [PMID: 26499915 PMCID: PMC4816073 DOI: 10.1177/1479164115609027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY To examine differences in the characteristics, treatment practices and in-hospital outcomes of patients with and without previously diagnosed diabetes hospitalized for non-ST segment elevation myocardial infarction. KEY METHODS The study cohort consisted of 3916 patients diagnosed with non-ST segment elevation myocardial infarction at all 11 central MA medical centres between 1999 and 2009, of whom 1475 (38%) had been previously diagnosed with diabetes. MAIN RESULTS Diabetic patients were more likely to have received treatment with effective cardiac medications, and to have undergone coronary bypass surgery, but were less likely to have received a percutaneous coronary intervention, than non-diabetic patients. Patients with a history of diabetes were more likely to have developed cardiogenic shock, heart failure and died during their index hospitalization than non-diabetic patients. MAIN CONCLUSION Diabetic patients presenting with non-ST segment elevation myocardial infarction remain at high risk of developing significant clinical complications during hospitalization.
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Affiliation(s)
- Hamza H Awad
- Department of Community Medicine/Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Mayra Tisminetzky
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Diana Metry
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - David McManus
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Stamboul K, Fauchier L, Gudjoncik A, Buffet P, Garnier F, Lorgis L, Beer JC, Touzery C, Cottin Y. New insights into symptomatic or silent atrial fibrillation complicating acute myocardial infarction. Arch Cardiovasc Dis 2015; 108:598-605. [PMID: 26525569 DOI: 10.1016/j.acvd.2015.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 10/22/2022]
Abstract
Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF in the acute phase of myocardial infarction (MI) is a major event that can jeopardize the prognosis of patients in the short-, medium- and long-term, and is a powerful predictor of a poor prognosis after MI. The suspected mechanism underlying the excess mortality is the drop in coronary flow linked to the acceleration and arrhythmic nature of the left ventricular contractions, which reduce the left ventricular ejection fraction. The principal causes of AF-associated death after MI are linked to heart failure. Moreover, the excess risk of death in these heart failure patients has also been associated with the onset of sudden death. Whatever its form, AF has a major negative effect on patient prognosis. In recent studies, symptomatic AF was associated with inhospital mortality of 17.8%, to which can be added mortality at 1year of 18.8%. Surprisingly, silent AF also has a negative effect on the prognosis, as it is associated with an inhospital mortality rate of 10.4%, which remains high at 5.7% at 1year. Moreover, both forms of AF are independent predictors of mortality beyond traditional risk factors. The frequency and seriousness of silent AF in the short- and long-term, which were until recently rarely studied, raises the question of systematically screening for it in the acute phase of MI. Consequently, the use of continuous ECG monitoring could be a simple, effective and inexpensive solution to improve screening for AF, even though studies are still necessary to validate this strategy. Finally, complementary studies also effect of oxidative stress and endothelial dysfunction, which seem to play a major role in triggering this rhythm disorder.
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Affiliation(s)
- Karim Stamboul
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau University Hospital and François-Rabelais University, Tours, France
| | - Aurelie Gudjoncik
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | | | - Fabien Garnier
- Cardiology Department, University Hospital, Dijon, France
| | - Luc Lorgis
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | | | - Claude Touzery
- Cardiology Department, University Hospital, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France.
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Borah BJ, Roger VL, Mills RM, Weston SA, Anderson SS, Chamberlain AM. Association Between Atrial Fibrillation and Costs After Myocardial Infarction: A Community Study. Clin Cardiol 2015; 38:548-54. [PMID: 26418757 DOI: 10.1002/clc.22448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/24/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The authors sought to estimate incremental economic impact of atrial fibrillation (AF) and the timing of its onset in myocardial infarction (MI) patients. HYPOTHESIS Concurrent AF and its timing are associated with higher costs in MI patients. METHODS This retrospective cohort study included incident MI patients from Olmsted County, Minnesota, treated between November 1, 2002, and December 31, 2010. We compared inflation-adjusted standardized costs accumulated between incident MI and end of follow-up among 3 groups by AF status and timing: no AF, new-onset AF (within 30 days after index MI), and prior AF. Multivariate adjustment of median costs accounted for right-censoring in costs. RESULTS The final study cohort had 1389 patients, with 989 in no AF, 163 in new-onset AF, and 237 in prior AF categories. Median follow-up times were 3.98, 3.23, and 2.55 years, respectively. Mean age at index was 67 years, with significantly younger patients in the no AF group (64 years vs 76 and 77 years, respectively; P < 0.001). New-onset and prior AF patients had more comorbid conditions (hypertension, heart failure, and chronic obstructive pulmonary disease). After accounting for differences in baseline characteristics, we found adjusted median (95% confidence interval) costs of $73 000 ($69 000-$76 000) for no AF; $85 000 ($81 000-$89 000) for new-onset AF; and $97 000 ($94 000-$100 000) for prior AF. Inpatient costs composed the largest share of total median costs (no AF, 82%; new-onset AF, 84%; prior AF, 83%). CONCLUSIONS Atrial fibrillation frequently coexists with MI and imposes incremental costs, mainly attributable to inpatient care. Timing of AF matters, as prior AF was found to be associated with higher costs than new-onset AF.
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Affiliation(s)
- Bijan J Borah
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Roger M Mills
- Janssen Research and Development LLC (Mills), Johnson & Johnson, Raritan, New Jersey
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Coronary atherosclerosis and adverse outcomes in patients with recent-onset atrial fibrillation and troponin rise. Am J Emerg Med 2015; 33:1407-13. [PMID: 26272437 DOI: 10.1016/j.ajem.2015.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The relationship between troponin and atrial fibrillation (AF) without acute coronary syndrome is still unclear. We sought to investigate the presence of coronary atherosclerosis and adverse outcomes in patients with AF. METHODS Consecutive patients with recent-onset AF and without severe comorbidities were enrolled between 2004 and 2013. Patients with a troponin rise or with adverse outcomes were considered for coronary angiography and revascularization when "critical" stenosis (≥70%) was recognized. Propensity score matching was performed to adjust for baseline characteristics; after matching, no differences existed between the groups of patients with or without troponin rise. The primary end point was the composite of acute coronary syndrome, revascularization, and cardiac death at 1- and 12-month follow-ups. RESULTS Of 3627 patients enrolled, 3541 completed the study; 202 (6%) showed troponin rise; and 91 (3%), an adverse outcome. In the entire cohort, on multivariate analysis, the odds ratio for the occurrence of the primary end point of troponin rise was 14 (95% confidence interval [CI], 10-23; P<.001), and that of known coronary artery disease was 3 (CI, 2-5; P=.001). In the matching cohort, the odds ratio of troponin rise was 10 (CI, 4-22; P<.001), and that of TIMI score greater than 2 was 4 (CI, 2-9; P≤.001). In the entire cohort, patients with or without troponin rise achieved the primary end point in 38 (19%) and 43 (1%) patients, respectively (P<.001). Stroke occurred in 4 (2%) and 20 (1%), respectively (P=.018). Critical stenosis and revascularization account for 23 (12%) and 15 (1%), respectively (P<.001). In the matching cohort, results were confirmed, but incidence of stroke was comparable. CONCLUSIONS Patients with recent-onset AF and troponin rise showed higher prevalence of coronary atherosclerosis and adverse cardiac events. Stroke per se did not succeed in justifying the high morbidity. Thus, beyond stroke, coronary atherosclerosis might have a pivotal role in poor outcomes.
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Stamboul K, Lorin J, Lorgis L, Guenancia C, Beer JC, Touzery C, Rochette L, Vergely C, Cottin Y, Zeller M. Atrial Fibrillation Is Associated with a Marker of Endothelial Function and Oxidative Stress in Patients with Acute Myocardial Infarction. PLoS One 2015; 10:e0131439. [PMID: 26158510 PMCID: PMC4497674 DOI: 10.1371/journal.pone.0131439] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/01/2015] [Indexed: 12/29/2022] Open
Abstract
Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) ≥48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients without AF (≈ 20 y). There was a trend towards higher ADMA levels in patients with symptomatic AF than in patients with silent AF or no AF (0.53 vs 0.49 and 0.49 μmol/L, respectively, p = 0.18,). After matching on age, we found that patients with symptomatic AF had a higher heart rate on admission and a higher rate of patients with LV dysfunction (28% vs. 3%, p = 0.025). Patients who developed symptomatic AF had a higher ADMA level than patients without AF (0.53 vs. 0.43 μmol/L; p = 0.001). Multivariate logistic regression analysis to estimate symptomatic AF occurrence showed that ADMA was independently associated with symptomatic AF (OR: 2.46 [1.21–5.00], p = 0.013) beyond history of AF, LVEF<40% and elevated HR. Conclusion We show that high ADMA level is associated with the occurrence of AF. Although no causative role can be concluded from our observational study, our work further supports the hypothesis that endothelial dysfunction is involved in the pathogenesis of AF in AMI.
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Affiliation(s)
- Karim Stamboul
- Cardiology Department, University Hospital, Dijon, France
| | - Julie Lorin
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | - Luc Lorgis
- Cardiology Department, University Hospital, Dijon, France
| | | | | | - Claude Touzery
- Cardiology Department, University Hospital, Dijon, France
| | - Luc Rochette
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | - Catherine Vergely
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France
| | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
- * E-mail:
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Tisminetzky M, McManus DD, Erskine N, Saczynski JS, Yarzebski J, Granillo E, Gore J, Goldberg RJ. Thirty-day Hospital Readmissions in Patients with Non-ST-segment Elevation Acute Myocardial Infarction. Am J Med 2015; 128:760-5. [PMID: 25660250 PMCID: PMC4475427 DOI: 10.1016/j.amjmed.2015.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non-ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI. METHODS We reviewed the medical records of 2249 residents of the Worcester (Mass) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central Massachusetts medical centers. RESULTS The average age of our study population was 72 years, 90% were white, and 46% were women. The proportion of patients who were readmitted to the hospital for any cause within 30 days after discharge for an NSTEMI remained unchanged between 1999 and 2009 (approximately 15%) in both crude and multivariable adjusted analyses. Slight declines were observed for cardiovascular disease-related 30-day readmissions over the 10-year study period. Women, elderly patients, those with multiple chronic comorbidities or a prolonged index hospitalization, and patients who developed heart failure during their index hospitalization were at higher risk for being readmitted within 30 days than respective comparison groups. CONCLUSION Thirty-day hospital readmission rates after hospital discharge for a first NSTEMI remained stable between 1999 and 2009. We identified several groups at higher risk for hospital readmission; further surveillance efforts and/or tailored educational and treatment approaches remain needed for these groups.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Edgard Granillo
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joel Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester.
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Braga CG, Ramos V, Martins J, Arantes C, Abreu G, Vieira C, Salgado A, Gaspar A, Azevedo P, Álvares Pereira M, Magalhães S, Marques J. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Braga CG, Ramos V, Martins J, Arantes C, Abreu G, Vieira C, Salgado A, Gaspar A, Azevedo P, Álvares Pereira M, Magalhães S, Marques J. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. Rev Port Cardiol 2015; 34:403-10. [PMID: 26028489 DOI: 10.1016/j.repc.2015.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/01/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type - new-onset (nAF) or pre-existing (pAF) - is still controversial. OBJECTIVES To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS). METHODS We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.3% male) admitted to a single center over a three-year period, with a six-month follow-up. RESULTS AF rhythm was identified in 14.5% patients, of whom 71.4% presented nAF and 28.6% pAF. When AF types were compared, patients with nAF more frequently presented with ST-elevation ACS (p=0.003). Patients with pAF, in turn, were older (p=0.032), had greater left atrial diameter (p=0.001) and were less likely to have significant coronary lesions (p=0.034). Regarding therapeutic strategy, nAF patients were more often treated by rhythm control during hospital stay (p<0.001) and were less often anticoagulated at discharge (p=0.001). Compared with the population without AF, nAF was a predictor of death during hospital stay in univariate (p<0.001) and multivariate analysis (OR 2.67, p=0.047), but pAF was not. During follow-up, pAF was associated with higher mortality (p=0.014), while nAF patients presented only a trend towards worse prognosis. CONCLUSIONS AF during the acute phase of ACS appears to have a negative prognostic impact only in patients with nAF and not in those with pAF.
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Affiliation(s)
| | - Vítor Ramos
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Carina Arantes
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Glória Abreu
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | | | - António Gaspar
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Pedro Azevedo
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | | | - Jorge Marques
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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Tisminetzky M, McManus DD, Dor A, Miozzo R, Yarzebski J, Gore JM, Goldberg RJ. Decade-long trends (1999-2009) in the characteristics, management, and hospital outcomes of patients hospitalized with acute myocardial infarction with prior diabetes and chronic kidney disease. Int J Nephrol Renovasc Dis 2015; 8:41-51. [PMID: 25999755 PMCID: PMC4427079 DOI: 10.2147/ijnrd.s78749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999–2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities. Methods We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all eleven medical centers in central Massachusetts. Our sample consisted of the following four groups: DM with CKD (n=587), CKD without DM (n=524), DM without CKD (n=1,442), and non-DM/non-CKD (n=3,465). Results Diabetic patients with CKD were more likely to have a higher prevalence of previously diagnosed comorbidities, to have developed heart failure acutely, and to have a longer hospital stay compared with non-DM/non-CKD patients. Between 1999 and 2009, there were marked increases in the prescribing of beta-blockers, statins, and aspirin for patients with CKD and DM as compared to those without these comorbidities. In-hospital death rates remained unchanged in patients with DM and CKD, while they declined markedly in patients with CKD without DM (20.2% dying in 1999; 11.3% dying in 2009). Conclusion Despite increases in the prescribing of effective cardiac medications, AMI patients with DM and CKD continue to experience high in-hospital death rates.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Alon Dor
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Ruben Miozzo
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA ; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Joel M Gore
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
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Stamboul K, Zeller M, Fauchier L, Gudjoncik A, Buffet P, Garnier F, Guenancia C, Lorgis L, Beer JC, Touzery C, Cottin Y. Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up. Heart 2015; 101:864-9. [PMID: 25903836 DOI: 10.1136/heartjnl-2014-307253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/26/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in patients experiencing silent AF in AMI. METHODS All consecutive patients with AMI who were prospectively analysed by CEM during the first 48 h after admission and who survived at hospital discharge were included. Silent AF was defined as asymptomatic episodes lasting at least 30 s. Patients were followed up at 1 year for cardiovascular (CV) outcomes. RESULTS Among the 737 patients analysed, 106 (14%) developed silent AF and 32 (4%) symptomatic AF. Compared with the no-AF group, patients with silent AF were markedly older (79 vs 62 years, p<0.001), more frequently hypertensive (71% vs 49%, p<0.001) and less likely to be smokers (23% vs 37%, p<0.001). Also, they were more likely to have impaired LVEF (50% vs 55%, p<0.001). Risk factors in patients with silent AF were similar to those in patients with symptomatic AF. However, a history of stroke or AF was less frequent in silent AF than in symptomatic-AF patients (10% vs 25% and 10% vs 38%, respectively). At 1 year, CV events including hospitalisation for heart failure (HF) and CV mortality were markedly higher in silent-AF patients than in no-AF patients (6.6% vs 1.3% and 5.7% vs 2.0%, p<0.001, respectively). CONCLUSIONS Our large prospective study showed for the first time that silent AF is associated with worse 1-year prognosis after AMI. Systematic screening and specific management should be investigated in order to improve outcomes of patients after AMI.
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Affiliation(s)
- Karim Stamboul
- Cardiology Department, University Hospital, Dijon, France
| | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, University of Burgundy, Dijon, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau University Hospital and François Rabelais University, Tours, France
| | | | | | - Fabien Garnier
- Cardiology Department, University Hospital, Dijon, France
| | | | - Luc Lorgis
- Cardiology Department, University Hospital, Dijon, France
| | | | - Claude Touzery
- Cardiology Department, University Hospital, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France
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Consuegra-Sánchez L, Melgarejo-Moreno A, Galcerá-Tomás J, Alonso-Fernández N, Díaz-Pastor Á, Escudero-García G, Jaulent-Huertas L, Vicente-Gilabert M. Pronóstico a corto y largo plazo de la fibrilación auricular previa y de novo en pacientes con infarto agudo de miocardio con elevación del segmento ST. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ghushchyan V, Nair KV, Page RL. Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both. Vasc Health Risk Manag 2014; 11:25-34. [PMID: 25565859 PMCID: PMC4284047 DOI: 10.2147/vhrm.s72331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities. METHODS A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. RESULTS Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191) followed by ACS with HF ($32,871±2,853), ACS with AF ($25,192±2,253), and ACS only ($17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719-9,427), $11,297 (95% CI 5,610-16,985), and $15,761 (95% CI 4,784-26,738) higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions. CONCLUSION ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF.
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Affiliation(s)
- Vahram Ghushchyan
- College of Business and Economics, American University of Armenia, Yerevan, Armenia ; Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Kavita V Nair
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Robert L Page
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA ; Department of Physical Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
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44
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González-Pacheco H, Márquez MF, Arias-Mendoza A, Álvarez-Sangabriel A, Eid-Lidt G, González-Hermosillo A, Azar-Manzur F, Altamirano-Castillo A, Briseño-Cruz JL, García-Martínez A, Mendoza-García S, Martínez-Sánchez C. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. J Cardiol 2014; 66:148-54. [PMID: 25480145 DOI: 10.1016/j.jjcc.2014.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with an acute coronary syndrome (ACS), no conclusive agreement has been reached to date regarding the association between the different types of atrial fibrillation (AF) and the in-hospital mortality risk. We conducted a retrospective cohort study in patients with ACS to determine the prognostic implications of the different types of AF. METHODS We analyzed 6705 consecutive patients with ACS admitted to a coronary care unit (CCU), including 3094 with ST segment elevation myocardial infarction (STEMI) and 3611 with non-ST-elevation acute coronary syndrome (NSTE-ACS). We identified the patients with pre-existing AF, new-onset AF at admission, and new-onset AF at the CCU. RESULTS The overall incidence of AF was documented in 360 (5.4%) of the patients (STEMI, 5%; NSTE-ACS, 5.6%), 140 (2.1%) of whom had pre-existing AF, and 220 (3.2%) of whom had new-onset AF (AF at admission, 1.3%; AF at the CCU, 1.9%). The patients with AF had high-risk clinical characteristics and developed major adverse events more frequently than did the patients without AF. The unadjusted in-hospital mortality risk was significantly higher in the patients with pre-existing AF (STEMI, 3.79-fold; NSTE-ACS, 3.4-fold) and AF at the CCU (STEMI, 2.02-fold; NSTE-ACS, 8.09-fold). After adjusting for the multivariate analysis, only the AF at the CCU in the NSTE-ACS group was associated with a 4.40-fold increase in the in-hospital mortality risk (odds ratio 4.40, CI 1.82-10.60, p=0.001). In the STEMI group, the presence of any type of AF was not associated with an increased risk of mortality. CONCLUSION Among the different types of AF in patients with ACS, only the new-onset AF that developed during the CCU stay in patients with NSTE-ACS was associated with a 4.40-fold increase in the in-hospital mortality risk.
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Affiliation(s)
| | - Manlio F Márquez
- Cardiac Electrophysiology Laboratory, National Institute of Cardiology, Mexico City, Mexico
| | | | | | - Guering Eid-Lidt
- Catheterization Laboratory, National Institute of Cardiology, Mexico City, Mexico
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46
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Wang J, Yang YM, Zhu J. Mechanisms of new-onset atrial fibrillation complicating acute coronary syndrome. Herz 2014; 40 Suppl 1:18-26. [PMID: 25352243 DOI: 10.1007/s00059-014-4149-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 08/01/2014] [Accepted: 08/16/2014] [Indexed: 11/24/2022]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmia complications of acute coronary syndrome (ACS). The incidence of new-onset AF is 2.3-37 %, and it is an important predictor of a patient's morbidity, mortality, and prolonged hospitalization. Various risk factors for the development of new-onset AF after ACS have been identified, including: old age, higher Killip class, relevant history (e.g., hypertension), and enlarged left atrium. Insights into the pathophysiological mechanisms of new-onset AF have been provided by both experimental and clinical investigations and show that new-onset AF is multifactorial, involving atrial ischemia and atrial stretch, inflammation, autonomic nervous system activity, and hormone activation. An understanding of the mechanisms underlying new-onset AF complicating ACS can provide new insight of therapeutic importance.
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Affiliation(s)
- J Wang
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Ribeiro V, Pereira M, Melão F, Oliveira SM, Araújo C, Vila J, Dias P, Azevedo A. Determinants and outcomes of atrial fibrillation complicating myocardial infarction: the EURHOBOP study in Portugal. Int J Cardiol 2014; 176:1426-8. [PMID: 25147071 DOI: 10.1016/j.ijcard.2014.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/05/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Vânia Ribeiro
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar São João EPE, Porto, Portugal
| | - Marta Pereira
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Filipa Melão
- Department of Cardiology, Centro Hospitalar São João EPE, Porto, Portugal
| | | | - Carla Araújo
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Department of Cardiology, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, Vila Real, Portugal
| | - Joan Vila
- Group on Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Paula Dias
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar São João EPE, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
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Bengtson LG, Chen LY, Chamberlain AM, Michos ED, Whitsel EA, Lutsey PL, Duval S, Rosamond WD, Alonso A. Temporal trends in the occurrence and outcomes of atrial fibrillation in patients with acute myocardial infarction (from the Atherosclerosis Risk in Communities Surveillance Study). Am J Cardiol 2014; 114:692-7. [PMID: 25048343 DOI: 10.1016/j.amjcard.2014.05.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
Atrial fibrillation (AF) frequently coexists in the setting of myocardial infarction (MI), being associated with increased mortality. Nonetheless, temporal trends in the occurrence of AF complicating MI and in the prognosis of these patients are not well described. We examined temporal trends in prevalence of AF in the setting of MI and the effect of AF on prognosis in the community. We studied a population-based sample of 20,049 validated first-incident nonfatal hospitalized MIs among 35- to 74-year old residents of 4 communities in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 through 2009. Prevalence of AF in the setting of MI increased from 11% to 15% during the 23-year study period. The multivariable adjusted odds ratio for prevalent AF, per 5-year increment, was 1.11 (95% confidence interval 1.04 to 1.19). Overall, in patients with MI, AF was associated with increased 1-year case fatality (odds ratio 1.47, 95% confidence interval 1.07 to 2.01) compared with those without AF. However, there was no evidence that the impact of AF on MI survival changed over time or differed over time by sex, race, or MI classification (all p values >0.10). In conclusion, co-occurrence of AF in MI slightly increased between 1987 and 2009. The adverse impact of AF on survival in the setting of MI was consistent throughout. In the setting of MI, co-occurrence of AF should be viewed as a critical clinical event, and treatment needs unique to this population should be explored further.
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Consuegra-Sánchez L, Melgarejo-Moreno A, Galcerá-Tomás J, Alonso-Fernández N, Díaz-Pastor Á, Escudero-García G, Jaulent-Huertas L, Vicente-Gilabert M. Short- and long-term prognosis of previous and new-onset atrial fibrillation in ST-segment elevation acute myocardial infarction. ACTA ACUST UNITED AC 2014; 68:31-8. [PMID: 25131442 DOI: 10.1016/j.rec.2014.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The impact of atrial fibrillation on the prognosis of myocardial infarction is still the subject of debate. We analyzed the influence of previous and new-onset atrial fibrillation on in-hospital and long-term prognosis in patients with acute myocardial infarction. METHODS Prospective study of 4284 patients with ST-segment elevation acute myocardial infarction. We studied all-cause in-hospital and long-term mortality (median, 7.2 years) using adjusted models. RESULTS In total, 3.2% of patients had previous atrial fibrillation and 9.8% had new-onset atrial fibrillation. In general, both groups of patients had a high baseline risk profile and an increased likelihood of in-hospital complications. The crude in-hospital mortality rate was higher in patients with previous atrial fibrillation than in those with new-onset atrial fibrillation (22% vs 12%; P<.001; 30% vs 10%; P<.001). The long-term mortality rate was 11.11/100 patient-years in patients with previous atrial fibrillation and 5.35/100 patient years in those with new-onset atrial fibrillation (both groups, P<.001). New-onset fibrillation alone (odds ratio=1.55; 95% confidence interval, 1.08-2.22) was an independent predictor of in-hospital mortality. Previous atrial fibrillation (hazard ratio=1.24; 95% confidence interval, 0.94-1.64) and new-onset atrial fibrillation (hazard ratio=0.98; 95% confidence interval, 0.80-1.21) were not independent predictors of long-term mortality. CONCLUSIONS New-onset atrial fibrillation during hospitalization is an independent risk factor for in-hospital mortality in acute myocardial infarction.
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Affiliation(s)
| | - Antonio Melgarejo-Moreno
- Servicio de Medicina Intensiva, Hospital General Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - José Galcerá-Tomás
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Nuria Alonso-Fernández
- Servicio de Medicina Intensiva, Hospital General Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - Ángela Díaz-Pastor
- Servicio de Medicina Intensiva, Hospital General Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - Germán Escudero-García
- Servicio de Medicina Intensiva, Hospital General Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - Leticia Jaulent-Huertas
- Servicio de Cardiología, Hospital General Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - Marta Vicente-Gilabert
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
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50
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Giglioli C, Minelli M, Chiostri M, Landi D, Romano SM, Balzi D, Valente S, Padeletti L, Gensini GF, Cecchi E. Prognostic impact of atrial fibrillation occurrence in patients with non-ST-elevation acute coronary syndromes: is dysrhythmia duration a parameter to focus on? Intern Emerg Med 2014; 9:521-8. [PMID: 23729385 DOI: 10.1007/s11739-013-0959-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/13/2013] [Indexed: 01/19/2023]
Abstract
Several studies have evaluated the prognostic impact of atrial fibrillation (AF) in ST-elevation myocardial infarction (STEMI) patients, but scarce data are available on the role of AF in non-ST-elevation acute coronary syndromes (NSTE-ACS). The aim of this study was to investigate long-term outcome of NSTE-ACS patients experiencing an episode of AF during in-hospital course. Of 1,147 NSTE-ACS patients, 54.4% for non-STEMI (NSTEMI) and 45.6% for unstable angina, 65 (5.7%) had an episode of AF. Long-term survival was compared with that of 1,082 NSTE-ACS patients who did not develop AF. Patients who developed AF, with respect to those who did not, were older and more frequently with NSTEMI at admission (69.2 vs. 53.5%, p = 0.013), diabetes, dyslipidemia and history of heart failure. Moreover, patients who developed AF had a significantly higher New York Heart Association class and lower values of glomerular filtration rate. During a median follow-up of 40.7 months, we observed a significantly higher mortality in NSTE-ACS patients who developed AF versus those who did not (42.2 vs. 19.8%, p < 0.001). AF occurrence in NSTE-ACS was a significant predictor of mortality at Cox regression (adjusted HR: 1.85; p = 0.03). After propensity score analysis, only patients with AF duration >6 h showed a significantly higher mortality at Cox regression (p = 0.021). Our results suggest that NSTE-ACS patients who develop AF are characterized by a higher clinical complexity. The occurrence of AF, when longer than 6 h, represents an important negative prognostic factor for long-term survival.
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Affiliation(s)
- Cristina Giglioli
- Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, 50134, Florence, Italy,
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