title: Long term prognosis of atrial fibrillation in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a well-known complication in the setting of ST elevation myocardial infarction (STEMI). Data on the long-term prognostic implications of New-Onset AF (NOAF) complicating STEMI in the era of complete revascularization remains controversial. Our aim therefore was to evaluate the long-term prognosis of prior AF (pAF) and new-onset AF (NOAF) in STEMI patients undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  We studied 1657 consecutive STEMI patients hospitalized in the cardiac intensive care unit during 2008-2014. We reviewed patient records for the occurrence of pAF and NOAF. NOAF was defined as AF occurring within 30days of the STEMI episode. Patients were followed for a mean period of 3.4±2.1years.
  
  
  RESULTS
  Within our cohort 77 (4.6%) patients had pAF and 47 (2.8%) had NOAF. Patients with any AF were older and had a reduced systolic ejection fraction. Thirty-day mortality and all-cause mortality rates were significantly higher in patients with pAF in comparison to those without AF (9.1% vs. 2.2% p<0.001 and 31.2% vs. 9.4%, p<0.001, respectively). NOAF showed a trend for increased all-cause mortality (17% vs. 9.1%, p=0.07) and 30-days mortality (6.4% vs. 2.1%. p=0.09). In a multivariate regression model, pAF but not NOAF was a predictor of mortality throughout the follow-up period (HR 2.02, 95% CI 1.2 to 3.1, p=0.005 and HR 1.1, 95% CI 0.56 to 2.2, p=0.75, respectively).
  
  
  CONCLUSIONS
  Prior AF and not new-onset AF is an independent predictor of both short and long term mortality in patients treated with PCI.
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Topaz
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Flint
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel.
authors.forename: Arik
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel.
authors.forename: Yacov
authors.initials: Y
authors.lastname: Shacham
authors.affiliation: Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel; Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York. Electronic address: lioryan@gmail.com.
authors.forename: Lior
authors.initials: L
authors.lastname: Yankelson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors
keywords: Atrial fibrillation (AF); Mortality; Percutaneous coronary intervention (PCI); ST elevation MI (STEMI)