Author + information
- Elsayed Z. Soliman,
- Monika Safford,
- Paul Muntner,
- Yulia Khodneva,
- Suzanne Judd,
- Farah Dawood,
- Evan Thacker,
- Neil A. Zakai,
- Virginia Howard,
- George Howard,
- David Herrington and
- Mary Cushman
Sporadic cases of acute myocardial infarction [MI] have been reported in patients with atrial fibrillation [AF], and AF during acute MI is associated with increased risk of in-hospital re-infarction. However, despite shared risk factors, the role of AF as a risk factor for MI has not been studied.
This analysis included 23,928 participants aged > 45 years without prior coronary heart disease from the REasons for Geographic and Racial Differences in Stroke [REGARDS] study. Baseline AF was detected using electrocardiogram [ECG] and self-reported history of a previous physician diagnosis. Incident fatal and non-fatal MI cases were identified and adjudicated during up to 6.9 years of follow-up [median 4.5 years].
A total of 648 incident MIs occurred during follow-up. In a Cox Proportional hazard model adjusted for sociodemographics, AF was associated with a two-fold risk of MI [HR (95% CI): 1.96 (1.52-2.52), p<0.001]. After further adjustment for cardiovascular risk factors and potential confounders, AF was still associated with 70% increase in the risk of MI (p<0.001) (Table). The risk of MI was significantly larger in women than men and in blacks than whites (interaction p for both <0.04) (Table).
AF was independently associated with an increased risk of incident MI. Findings add to our evolving understanding of the seriousness of AF as a public health burden; not only does AF predispose to stroke but it increases the risk of MI as well, especially in women and blacks.
|Subgroups||Atrial Fibrillation||No Atrial Fibrillation||HR (95% CI)*||p-value for interaction|
|Participants, (n)||Events (n)||Participants, (n)||Events (n)|
|All participants||1631||78||22297||570||1.70 (1.26–2.30)||…|
|Age < 65 years||727||19||12201||217||1.28 (0.74–2.21)||0.45|
|Age ≥ 65 years||904||59||10096||353||2.06 (1.44–2.94)|
↵* Model adjusted for sociodemographics [age, sex, race/ethnicity, region of residence, education level, and income] cardiovascular risk factors [total cholesterol, HDL cholesterol, smoking status, systolic blood pressure, body mass index, diabetes and history of prior non-cardiac vascular disease], inflammation [high-sensitivity C-reactive protein], kidney function [estimated glomerular filtration rate < 60 ml/min/kg/m2 and albumin-to-creatinine ratio] and medications [blood pressure lowering drugs, warfarin, aspirin and statins].
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT III
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1151-49
- 2013 American College of Cardiology Foundation