title: The significance of new onset atrial fibrillation complicating acute myocardial infarction.
abstract: BACKGROUND
  Atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) independently predicts in-hospital and long-term morbidity and mortality. Very little data exist regarding the prognostic significance and management of new-onset AF in this setting in the era of dual anti-platelet therapy.
  
  
  METHODS
  We identified all patients admitted to our coronary care unit for AMI between 2002 and 2009 who developed new-onset AF. The control group was an age and gender matched group of AMI patients who did not have AF. Management and recurrent AF, non-fatal stroke, and mortality data were collected from subsequent hospitalizations and outpatient records.
  
  
  RESULTS
  Of 1,991 AMI admissions, new-onset AF was diagnosed in 100 (4.1%). Patients' age was 70 (±12), 32% were female, 58% had ST-elevation AMI and 53% had moderate or worse systolic dysfunction. AF recurred during index admission in 33%. During mean follow-up of 41 months, AF recurred in 22 and 4.5%, and non-fatal stroke occurred in 13 and 1% of the AF and control groups, respectively (p < 0.01 for both). The composite of death and non-fatal stroke was also significantly higher in the AF group, 39 versus 29% (p = 0.02). Oral anti-coagulation was used in only 24% of the AF group and was a significant predictor of stroke-free survival (p = 0.04).
  
  
  CONCLUSIONS
  New onset AF in the AMI setting carries a substantial future risk for stroke and should not be regarded as a benign, transient complication of the acute event. Long term anticoagulation is underused and is associated with improved stroke-free survival.
authors: Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. zusmanor@bgu.ac.il
authors: Oren
authors: O
authors: Zusman
authors: Guy
authors: G
authors: Amit
authors: Harel
authors: H
authors: Gilutz
authors: Doron
authors: D
authors: Zahger
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015996:Survival Rate
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors