title: Prognosis of different types of atrial fibrillation in the primary angioplasty era.
abstract: BACKGROUND
  Atrial fibrillation (AF) has been associated with a poor prognosis in patients with ST-segment elevation myocardial infarction. There is considerable controversy regarding the prognostic implications of different types of AF.
  
  
  RESULTS
  We analyzed 913 patients consecutively admitted to our center with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Clinical, ECG, and angiographic data were collected. We carried out univariate and multivariate analysis, using a combined endpoint of death, reinfarction, stroke, and clinically relevant bleeding. AF was documented in 117 patients. Among them, 25 presented AF at admission (previous AF) and 92 developed new-onset AF (66% transient, 13% persistent). Patients with AF were older, more frequently men, and had a worse Killip class, and a poorer left-ventricular ejection fraction. When analyzing the different types of AF, patients with new-onset AF (persistent and transient) had a higher Killip class and a worse left-ventricular ejection fraction. AF was associated with significantly higher in-hospital mortality and with a greater incidence of in-hospital adverse events. An increase in in-hospital mortality was recorded both for previous and for new-persistent AF, but after adjusting for confounding factors, only persistent AF was found to carry a worse short-term prognosis.
  
  
  CONCLUSIONS
  In patients undergoing primary angioplasty in the stent era, AF is associated with a poor prognosis. This risk appears to be particularly high among patients with persistent AF.
authors.affiliation: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain. dafne.viliani@gmail.com
authors.forename: Dafne
authors.initials: D
authors.lastname: Viliani
authors.forename: David
authors.initials: D
authors.lastname: Vivas
authors.forename: Monica
authors.initials: M
authors.lastname: Chung
authors.forename: María J
authors.initials: MJ
authors.lastname: Pérez-Vizcayno
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome