Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction.
OBJECTIVE
To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD).


METHODS
The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and/or LVSD. AF was assessed at presentation and at randomization (median 4.9 days after symptom onset). Primary outcomes were risk of death and major CV events 3 years following acute MI.


RESULTS
A total of 1812 with current AF (AF between presentation and randomization), 339 patients with prior AF (history of AF without current AF), and 12,509 without AF were enrolled. Patients with AF were older; had more prior HF, angina, and MI, and received beta-blockers and thrombolytics less often than those without AF. Three-year mortality estimates were 20% in those without AF, 37% with current AF, and 38% with prior AF. Compared with patients without AF, the multivariable adjusted HR of death was 1.25 (1.03-1.52; p=0.03) for prior AF and 1.32 (1.20-1.45; p<0.0001) for current AF. HR for major CV events was 1.15 (0.98-1.35; p=0.08) and 1.21 (1.12-1.31; p<0.0001).


CONCLUSIONS
AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD.
Køber
Lars
L
Department of Cardiology, Non-Invasive Lab, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark. LK@HEART.DK
Swedberg
Karl
K
McMurray
John J V
JJ
Pfeffer
Marc A
MA
Velazquez
Eric J
EJ
Diaz
Rafael
R
Maggioni
Aldo P
AP
Mareev
Viatcheslav
V
Opolski
Grzegorz
G
Van de Werf
Frans
F
Zannad
Faiez
F
Ertl
Georg
G
Solomon
Scott D
SD
Zelenkofske
Steven
S
Rouleau
Jean-Lucien
JL
Leimberger
Jeffrey D
JD
Califf
Robert M
RM
D000208:Acute Disease; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002216:Captopril / Q000627:therapeutic use; D002303:Cardiac Output, Low / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013777:Tetrazoles / Q000627:therapeutic use; D013997:Time Factors; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000150:complications*
D047228:Angiotensin II Type 1 Receptor Blockers; D013777:Tetrazoles; D000068756:Valsartan; D002216:Captopril; D014633:Valine