Download Association with acute ischemia and predictors of new

Association with acute ischemia and predictors of new-onset atrial fibrillation in
ST-segment elevation myocardial infarction
Pedro Magalhães, Sílvia Leão, Filipa Cordeiro, Pedro Mateus, Sofia Carvalho, J.Ilídio
Moreira
Introduction/goal
New-onset atrial fibrillation (NOAF) is a relatively common complication of acute
myocardial infarction, associated with more adverse events and higher mortality.
Proposed mechanisms are complex and still misunderstood and include atrial and
ventricular ischemia with consequent neuro-humoral abnormalities and hemodynamic
changes. The aims of this study were to evaluate the relationship between acute
ischemia and NOAF and to identify predictors of NOAF in ST-segment elevation
myocardial infarction (STEMI) patients (pts).
Methods
We retrospectively analysed the registries of pts with STEMI included in the National
Registry of Acute Coronary Syndromes, between October of 2010 and October 2014.
NOAF was defined as paroxysmal or persistent atrial fibrillation unknown prior to
admission. Demographic data, cardiovascular risk factors and previous history,
admission data, coronary angiography results, treatment and complications during
hospitalization were analysed and multivariate analysis was performed in order to
identify predictors of NOAF.
Results
A total of 4566 STEMI pts were considered, 306 (6.7%) with NOAF. These pts were
significantly older, more frequently hypertensive and diabetic and had a higher
prevalence of previous heart failure (HF), valvular heart disease, stroke, peripheral
artery disease, renal failure, chronic obstructive lung disease and dementia. They
presented more frequently with HF at admission (27.8% of NOAF pts had a Killip class
>1 vs 13.8% of pts without NOAF; p<0.001). There were no differences between the
two groups regarding total ischemic time (TIT), culprit lesion, number of diseased
vessels and percentage of reperfused pts. Stroke (2.0% vs 0.8%; p=0.043), need for
blood transfusion (5.2% vs 1.9%; p<0.001) and in-hospital mortality (15.7% vs 5.3%;
p<0.001) were higher among NOAF pts. In multivariate analysis older age (OR 1.03,
CI95% 1.02-1.05; p<0.001), dementia (OR 2.54, CI95% 1.16-5.56; p=0.020) and Killip
class>1 at admission (OR 1.82, CI95% 1.23-2.69, p=0.003) were independently related
to the risk of developing NOAF.
Discussion/Conclusions
In this analysis of STEMI pts no clear association between NOAF and acute ischemia
was found as the two groups were similar regarding TIT, culprit lesion, number of
diseased vessels and percentage of acute reperfusion. NOAF was associated with inhospital stroke and mortality. Older age, dementia and HF at admission were
independent predictors of NOAF.