Atrial Fibrillation and Risk of ST-Segment-Elevation Versus Non-ST-Segment-Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study.
BACKGROUND
It has recently been reported that atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association is currently unknown. Further study of the relationship of AF with the type of MI (ST-segment-elevation MI [STEMI] versus non-ST-segment-elevation MI [NSTEMI]) might shed light on the potential mechanisms.


RESULTS
We examined the association between AF and incident MI in 14 462 participants (mean age, 54 years; 56% women; 26% blacks) from the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary heart disease at baseline (1987-1989) with follow-up through December 31, 2010. AF cases were identified from study visit ECGs and by review of hospital discharge records. Incident MI and its types were ascertained by an independent adjudication committee. Over a median follow-up of 21.6 years, 1374 MI events occurred (829 NSTEMIs, 249 STEMIs, 296 unclassifiable MIs). In a multivariable-adjusted model, AF (n=1545) as a time-varying variable was associated with a 63% increased risk of MI (hazard ratio,1.63; 95% confidence interval, 1.32-2.02). However, AF was associated with NSTEMI (hazard ratio, 1.80; 95% confidence interval, 1.39-2.31) but not STEMI (hazard ratio, 0.49; 95% confidence interval, 0.18-1.34; P for hazard ratio comparison=0.004). Combining the unclassifiable MI group with either STEMI or NSTEMI did not change this conclusion. The association between AF and MI, total and NSTEMI, was stronger in women than in men (P for interaction <0.01 for both).


CONCLUSIONS
AF is associated with an increased risk of incident MI, especially in women. However, this association is limited to NSTEMI.
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.). esoliman@wakehealth.edu.
Elsayed Z
EZ
Soliman
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Faye
F
Lopez
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Wesley T
WT
O'Neal
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Lin Y
LY
Chen
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Lindsay
L
Bengtson
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Zhu-Ming
ZM
Zhang
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Laura
L
Loehr
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Mary
M
Cushman
From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.).
Alvaro
A
Alonso
D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D050197:Atherosclerosis / Q000150:complications / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology*; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000002:abnormalities / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000453:epidemiology* / Q000503:physiopathology; D009765:Obesity / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
atrial fibrillation; electrocardiography; epidemiology; myocardial infarction