Clinical factors associated with the development of atrial fibrillation in the year following STEMI treated by primary PCI

Relationship Between Prognostic Nutritional Index and New-Onset Atrial Fibrillation in Patients with Acute ST-Elevation Myocardial Infarction Following Percutaneous Coronary Intervention

Multiple reports relate new-onset atrial fibrillation (NOAF) to poor clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) who received percutaneous coronary intervention (PCI). The prognostic nutritional index (PNI) is a reliable indicator of immunonutritional-inflammatory status, and it is linked to clinical outcomes in cardiovascular disease patients. This research aims to explore the relationship between NOAF and PNI.Overall, 600 STEMI patients treated with PCI were recruited for this retrospective analysis. The patients were categorized into the NOAF group or sinus rhythm (SR) group. Logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to assess PNI estimation. Lastly, the Kaplan-Meier curve was used to compare all-cause mortality between both groups.The combined NOAF incidence in PCI-treated STEMI patients was 7.7%. PNI was independently correlated with NOAF using multivariate regression analyses (odds ratio [OR], 0.824; 95% confidence interval [CI], 0.750-0.906; P < 0.001). In ROC curve analyses, the best PNI threshold value for predicting NOAF was 40.1, with sensitivity, and specificity of 76.09% and 71.30%, respectively area under the curve, 0.787; 95% CI, 0.752-0.819; P < 0.001). After a median of 41-month follow-up, the Kaplan-Meier curve revealed that the NOAF patients displayed an elevated all-cause death incidence compared with SR patients, with a log-rank of P = 0.005.This study demonstrated that PNI is an independent predictor of NOAF in STEMI patients during hospitalization after PCI, which is strongly correlated with a poor outcome upon discharge.

Oral anticoagulant therapy for patients with new-onset atrial fibrillation following acute myocardial infarction: A narrative review

Background

To evaluate the advantages and disadvantages of anticoagulant therapy and provide a piece of information on anti-thrombotic treatment strategies for patients with new-onset atrial fibrillation (NOAF) and acute myocardial infarction (AMI).

Methods

Literature from PubMed and Google scholar were screened until August 2022. Studies assessing oral anticoagulant (OAC) treatments for NOAF in patients with AMI were evaluated for inclusion.

Results

Three retrospective cohort studies were included. In the study performed by Madsen et al., patients with previously diagnosed AMI with or without NOAF were followed up for 5.8 years. About 38% of NOAF patients with anticoagulant therapies, which could reduce long-term mortality [adjusted hazard ratio (HR): 0.69; 95% confidence interval (CI): 0.47–1.00]. Hofer et al. performed a single-center cohort study containing 1,372 patients with AMI with an 8.6-year follow-up period. Dual anti-thrombotic therapy (DAT) did not show the effect on the survival in NOAF (adjusted HR: 0.97; 95% CI: 0.65–1.57), while triple antithrombotic therapy (TAT) could reduce long-term cardiovascular mortality (adjusted HR: 0.86; 95% CI: 0.45–0.92). Petersen et al. also did a cohort study with 1-year follow-up duration. It showed that anticoagulant therapies demonstrated positive results (HR: 0.78; 95% CI: 0.41–1.47).

Conclusion

Recent studies have shown that anticoagulant therapy in AMI-NOAF patients can obviously reduce the mortality of AMI-NOAF patients, especially OAC therapy. Further clinical trials could confirm these findings.

Triglyceride-Glucose Index and New-Onset Atrial Fibrillation in ST-Segment Elevation Myocardial Infarction Patients After Percutaneous Coronary Intervention

Background

New-onset atrial fibrillation (NOAF) is associated with worse prognostic outcomes in cases diagnosed with ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, as a credible and convenient marker of insulin resistance, has been shown to be predictive of outcomes for STEMI patients following revascularization. The association between TyG index and NOAF among STEMI patients following PCI, however, has not been established to date.

Objective

To assess the utility of the TyG index as a predictor of NOAF incidence in STEMI patients following PCI, and to assess the relationship between NOAF and long-term all-cause mortality.

Methods

This retrospective cohort research enrolled 549 STEMI patients that had undergone PCI, with these patients being clustered into the NOAF group and sinus rhythm (SR) group. The predictive relevance of TyG index was evaluated through logistic regression analyses and the receiver operating characteristic (ROC) curve. Kaplan-Meier curve was employed to explore differences in the long-term all-cause mortality between the NOAF and SR group.

Results

NOAF occurred in 7.7% of the enrolled STEMI patients after PCI. After multivariate logistic regression analysis, the TyG index was found to be an independent predictor of NOAF [odds ratio (OR): 8.884, 95% confidence interval (CI): 1.570–50.265, P = 0.014], with ROC curve analyses further supporting the predictive value of this parameter, which exhibited an area under ROC curve of 0.758 (95% CI: 0.720–0.793, P < 0.001). All-cause mortality rates were greater for patients in the NOAF group in comparison with the SR group over a median 35-month follow-up period (log-rank P = 0.002).

Conclusions

The TyG index exhibits values as an independent predictor of NOAF during hospitalization, which indicated a poorer prognosis after a relatively long-term follow-up.

Laser vaporization of atherothrombotic burden before drug-coated balloon application in ST-segment elevation myocardial infarction: Two-year outcomes of the laser-DCB trial

OBJECTIVES

This study aimed to examine whether the combination of excimer laser coronary atherectomy (ELCA) and drug-coated balloon (DCB) angioplasty can provide feasible clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) with 8-month and 2-year scheduled follow-up angiography.

BACKGROUND

Intracoronary thrombus elevates the risk of interventional treatment in patients with STEMI and hampers drug absorption into the vasculature released from DCB.

METHODS

Sixty-two patients with STEMI within 24 h after the onset of symptoms were enrolled in this prospective, single-center, single-arm study.

RESULTS

The laser catheter was successfully crossed distal to the culprit lesion in all cases. No ELCA-related adverse events occurred. Bail-out stenting was required in two patients (3.2%) after adjunctive ballooning; thus, the remaining 60 patients were completed with DCB angioplasty without stenting. Scheduled angiography at 8 months and 2 years was completed in 100% and 85.2%, respectively, and minimal lumen diameters were 3.4 ± 0.5, 3.4 ± 0.6, and 3.4 ± 0.5 mm after the procedure, at 8 months and at 2 years, respectively. Binary restenosis was observed in five patients (8.1%) in whom target lesion revascularization was performed. The duration of dual antiplatelet therapy was 2.3 ± 2.2 months, and neither abrupt vessel closure, reinfarction, cardiac death nor major bleeding was observed.

CONCLUSION

A combination of DCB angioplasty with ELCA is a feasible therapeutic option for STEMI.

Comprehensive Use of Routine Clinical Parameters to Identify Patients at Risk of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

(1) Background: New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI). Our study aimed to investigate whether routinely checked clinical parameters aid in NOAF identification in modernly treated AMI patients. (2) Patients and methods: Patients admitted consecutively within 2017 and 2018 to the University Clinical Centre in Gdańsk (Poland) with AMI diagnosis (necrosis evidence in a clinical setting consistent with acute myocardial ischemia) were enrolled. Medical history and clinical parameters were checked during NOAF prediction. (3) Results: NOAF was diagnosed in 106 (11%) of 954 patients and was significantly associated with in-hospital mortality (OR 4.54, 95% CI 2.50-8.33, p < 0.001). Age, B-type natriuretic peptide (BNP), C-reactive protein (CRP), high-sensitivity troponin I, total cholesterol, low-density lipoprotein cholesterol, potassium, hemoglobin, leucocytes, neutrophil/lymphocyte ratio, left atrium size, and left ventricular ejection fraction (LVEF) were associated with NOAF in the univariate logistic analysis, whereas age ≥ 66 yo, BNP ≥ 340 pg/mL, CRP ≥ 7.7 mg/L, and LVEF ≤ 44% were associated with NOAF in the multivariate analysis. (4) Conclusions: NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Simple, routinely checked clinical parameters could be helpful indices of this arrhythmia in current invasively treated patients with AMI.

Long-term prognostic outcomes and implication of oral anticoagulants in patients with new-onset atrial fibrillation following st-segment elevation myocardial infarction

BACKGROUND

New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted.

METHODS

A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes.

RESULTS

Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049).

CONCLUSIONS

NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.

The common characteristics and mutual effects of heart failure and atrial fibrillation: initiation, progression, and outcome of the two aging-related heart diseases

Atrial fibrillation (AF) and heart failure (HF) are common chronic diseases noted in humans. AF and HF share several risk factors, such as age, hypertension, obesity, diabetes, and dyslipidemia. They can interact with each other, while both their morbidity and mortality have been considerably increased. And AF and HF often occur together, suggesting a strong association between the two. However, the underlying mechanism behind this association is not well understood. Among them, aging is the most significant common risk factor, which represents an aging heart and is characterized by fibrosis and decreased number of cardiomyocytes, known as senescence-related cardiac remodeling for both atria and ventricles. Finally, it is proposed that cardiac remodeling is the key link between AF and HF.

MR-proANP level predicts new onset atrial fibrillation in patients with acute myocardial infarction

OBJECTIVE

MR-pro ANP is a novel peptide with multiple biological functions, especially within the cardiovascular system. It plays an important role in physiological and pathological processes in the human body and its level may be clinically relevant in new onset atrial fibrillation. The aim of this study was to determine whether elevated MR-proANP level is a predictor of new-onset atrial fibrillation in patients with acute myocardial infarction.

METHODS AND RESULTS

The study included 96 patients with their first diagnosis of acute myocardial infarction hospitalized in the Department of Interventional Cardiology within one year. The plasma levels of MR-proANP were determined on admission, and on the first and fifth day of hospitalisation by BRAHMS MRproANP KRYPTOR. New onset AF was diagnosed in 9.4% of patients during hospitalisation; the level of MR proANP was also found to be significantly higher in this group of patients compared to those without arrhythmia (p = 0.017). ROC curve analysis indicates that the concentration of MR-proANP is a good predictor of AF diagnosed during the hospitalisation in patients with acute myocardial infarction (AUC = 0.738, p = 0.0011).

CONCLUSIONS

MR-proANP might be a good predictor of new-onset atrial fibrillation in patients with acute myocardial infarction.

Incidence, predictors, and outcomes of new-onset atrial fibrillation in patients with ST-elevation myocardial infarction

BACKGROUND

Atrial fibrillation (AF) is a common arrhythmia and one of the complications in the setting of ST-elevation myocardial infarction (STEMI). Our objective of the present study was to investigate the incidence, predictors, and outcomes of NOAF in patients with acute STEMI managed with pharmacoinvasive strategy (PIS) versus those managed with primary percutaneous coronary intervention (PPCI).

METHODS

The study included 530 patients with STEMI divided into two groups according to the method of treatment. Group I: 269 patients subjected to pharmacoinvasive strategy (PIS), group II: 261 patients managed with primary percutaneous coronary intervention (PPCI). Incidence, predictors, and outcomes of NOAF were assessed in each group separately.

RESULTS

The incidence of NOAF was 25 patients (9.3%) in group I and 24 patients (9.2%) in group II. Multivariate regression analysis identified the independent predictors of NOAF that were (advanced age ˃65 years, history of hypertension, left atrial volume index (LAVI) ˃34 ml/m² , E/e' ratio ˃ 12, right coronary artery (RCA) as a culprit vessel and presence of heart failure). There was no statistically significant difference between both groups regarding the occurrence of MACE.

CONCLUSION

New-onset AF represents one of the common complications in the setting of STEMI. Advanced age, hypertension, LAVI ˃34 ml/m² , E/e' ratio ˃12, RCA culprit vessel, and heart failure were the independent predictors of NOAF.

The Warburg effect: A new insight into atrial fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia. Atrial remodeling, including electrical/structural/autonomic remodeling, plays a vital role in AF pathogenesis. All of these have been shown to contribute continuously to the self-perpetuating nature of AF. The Warburg effect was found to play important roles in tumor and non-tumor disease. Recently, lots of studies documented altered atrial metabolism in AF, but the specific mechanism and the impact of these changes upon AF initiation/progression remain unclear. In this article, we review the metabolic consideration in AF comprehensively and observe the footprints of the Warburg effect. We also summarize the signaling pathway involved in the Warburg effect during AF-HIF-1α and AMPK, and discuss their potential roles in AF maintenance and progression. In conclusion, we give the innovative idea that the Warburg effect exists in AF and promotes the progression of AF. Targeting it may provide new therapies for AF treatment.

New-Onset Atrial Fibrillation in the Post-Primary PCI Setting: A Systematic Review

Background: Atrial fibrillation is a relatively common complication of acute myocardial infarction with significant impact on the short and long-term prognosis.

Methods: A systematic literature review was done through Pubmed and CENTRAL to extract data related to new-onset atrial fibrillation following primary PCI.

Results: Searching resulted in twenty-one matched studies. Extraction of data showed an incidence rate of new-onset atrial fibrillation (2.8%-58%). A negative impact was found on the outcomes of patients treated with primary PCI with increased short and long-term mortality and morbidity.

Conclusion: New-onset atrial fibrillation is an adverse prognostic marker in patients with acute myocardial infarction treated invasively. Preventive measures and anticoagulant therapy should be considered more intensively in this subset of patients.

Predictive factors for new-onset atrial fibrillation in acute coronary syndrome patients undergoing percutaneous coronary intervention

BACKGROUND

The aim of this study is to investigate the predictive factors for new-onset atrial fibrillation (AF) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

METHODS

A total of 934 ACS patients admitted into the Department of Cardiology from February 2015 to February 2017 were collected. All patients were treated with PCI after admission and followed up for 1 year. Data of patients, such as age, gender, past medical history, dyslipidemia, cardiogenic shock, heart failure, medication, culprit vessel, echocardiographic characteristics and types of ACS were collected. Patients enrolled were divided into AF group and non-AF group according to whether there was new-onset AF or not. The clinical baseline data, coronary angiographic results and echocardiographic characteristics were compared between the two groups. The left atrial volume index (LAVI) and incidence rate of AF were compared using the histogram, and multivariate Logistic regression analyses were conducted for independent risk factors for new-onset AF in ACS patients undergoing PCI.

RESULTS

In terms of clinical baseline data and coronary angiographic results, the average age and proportions of female, hypertension, heart failure, cardiogenic shock and application of β-receptor blockers and antiarrhythmic drugs in AF group were significantly increased compared with those in non-AF group (P<0.05). In terms of echocardiographic characteristics, the mitral E peak, LAVI, and proportions of E/Em>15 and proportions of left ventricular ejection fraction (LVEF) <40% were significantly increased (P<0.05), but LVEF was obviously decreased (P<0.05) in AF group compared with those in non-AF group. According to multivariate Logistic regression analyses, cardiogenic shock, LAVI and age were independent risk factors for new-onset AF in ACS patients undergoing PCI. The comparison among patients with different LAVI showed that with the increase of LAVI, the incidence rate of AF was gradually increased.

CONCLUSIONS

Cardiogenic shock, LAVI and advanced age are independent predictive factors for new-onset AF in ACS patients undergoing PCI. The incidence rate of AF was gradually increased with the increase of LAVI.