Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction.
BACKGROUND
New-onset atrial fibrillation (AF) after acute myocardial infarction (AMI) frequently occurs in association with postinfarction complications, particularly with heart failure (HF).


OBJECTIVE
To evaluate whether postinfarction HF is associated with the subsequent development of AF and whether AF independently predicts poorer prognosis.


RESULTS
We examined 650 patients with AMI and compared patients with AF (n=320) to those without (n=330). AF patients were classified as either early AF (n=208)-patients who developed AF within 24 h of symptom onset or late AF (n=112)-patients who had AF thereafter. We compared outcomes between these groups, adjusting for differences in baseline characteristics and postinfarction HF. Heart failure was the most important predictor of AF. In most patients, AF occurred secondary to HF. AF patients had poorer outcomes, including higher in-hospital and 7-year mortality. After multivariate adjustment, overall, AF was not an independent predictor of in-hospital [odds ratio (OR)=0.70) and 7-year [relative risk (RR)=1.14] mortality, but late AF remained an independent predictor of 7-year (RR=2.48, 95% confidence interval, 1.26-4.87) mortality.


CONCLUSIONS
Heart failure mostly preceded the occurrence of new-onset atrial fibrillation after acute myocardial infarction, but only late atrial fibrillation was independently related to long-term mortality.
Asanin
Milika
M
University Institute for Cardiovascular Disease, Clinical Center of Serbia, Emergency Center, Pasterova 2, 11000 Belgrade, Serbia&Montenegro. masanin@Eunet.yu
Perunicic
Jovan
J
Mrdovic
Igor
I
Matic
Mihailo
M
Vujisic-Tesic
Bosiljka
B
Arandjelovic
Aleksandra
A
Vasiljevic
Zorana
Z
Ostojic
Miodrag
M
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology; D011379:Prognosis; D016019:Survival Analysis