Author + information
- Toshiro Tomomatsu,
- Itsuro Morishima,
- Takahito Sone,
- Hideyuki Tsuboi,
- Mititaka Uesugi,
- Etsushi Matsusita,
- Yasuhiro Morita,
- Tappei Furuta,
- Yasunori Kanzaki,
- Shinyu Ogasawara,
- Youhei Shibata,
- Kazushi Terada and
- Kazuhiro Naito
Although the presence of atrial fibrillation (AF) has been shown to have adverse prognostic implications in patients with acute myocardial infarction (Ml), little is known about the impact of AF type on mortalities in those patients. We hypothesized that transition from sinus rhythm to AF in the acute phase of Ml may further deteriorate hemodynamics leading to increased risk of mortality.
A total of 681 consecutive patients with acute Ml (age, 69±13 years old; male, 72%) were registered on admission. During index hospitalization period, AF was documented in 94 patients (AF group). The remaining 587 patients consist of non-AF group. The AF group was further divided into two groups; new-onset AF after admission (New-AF) group (n=68, 10.0%), and preexisting AF (Pre-AF) group (n=26, 3.8%). The cardiac mortality during 90 days after the onset of acute Ml was compared among the subgroups.
The AF group was older (75±11 vs. 68±13 years old, p<0.05) and had more impaired renal function (58±31 vs.82±39 ml/min./1.73m2, p<0.05) and a higher Killip class (2.3±1.1 vs.1.6±0.9 %, p<0.05) than the Non-AF group on admission. Cardiac deaths occurred in 61 patients (9.0%) during the follow-up period. Causes of death included pump failure (n=43), ventricular arrhythmias (n=10), and cardiac rupture (n=8). Cardiac mortality was significantly higher in AF group (n=24, 25.5%) than in Non-AF group (n=37, 6.3%) (hazard ratio [HR] 4.1, 95% confidence interval [CI] 2.4-6.8, p<0.0001). This worse prognosis persisted regardless of the type of AF: HR of 4.3 (95%CI = 2.4-7.5, p<0.001) for New-AF group and HR of 4.3 (95%CI = 1.8-10.3, p=0.001) for Pre-AF group when compared with Non-AF group. Cox regression analysis demonstrated that New-AF to be an independent predictor of cardiac mortality (HR=2.2, 95%CI=1.2-4.2, =0.02), whereas Pre-AF was not a significant predictor after adjusting the other co-factors (HR=1.2, 95%CI=0.4-4.2). New-AF was also disclosed to be an independent predictor of deaths due to pump failure (HR 2.2, CI 1.0-4.6, p=0.04).
New-AF, but not Pre-AF, may be an independent predictor of mid-term cardiac mortality, especially for pump failure death, in patients with acute MI.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT IV
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1152-57
- 2013 American College of Cardiology Foundation