Impact of Atrial Fibrillation During ST-Segment-Elevation Myocardial Infarction on Infarct Characteristics and Prognosis (original) (raw)
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Clinical Cardiology, 2018
Interatrial block (IAB) is strongly associated with recurrence of atrial fibrillation (AF) in different clinical scenarios. Atrial fibrosis is considered the responsible mechanism underlying the pathogenesis of IAB. The aim of this study was to investigate whether IAB predicted AF at 12 months follow-up in a population of patients with ST segment elevation myocardial infarction (STEMI). Hypothesis: We aimed to investigate whether IAB predicted AF at 12 months follow up in a population of patients with STEMI. Methods: Prospective, single center, observational study of patients presenting with STsegment elevation myocardial infarction (STEMI) and referred to primary percutaneous coronary intervention (P-PCI). Surface electrocardiograms (ECG) were recorded on admission and at 6th hour post P-PCI. Patients were screened for the occurrence of AF at a 12-months visit.
Circulation: Cardiovascular Imaging, 2013
Background— Infarct size (IS) determined by cardiac magnetic resonance (CMR) has proven an additional value, on top of left ventricular ejection fraction (LVEF), in prediction of adverse arrhythmic cardiac events (AACEs) in chronic ischemic heart disease. Its value soon after an acute ST-segment–elevation myocardial infarction remains unknown. Our aim was to determine whether early CMR can improve AACE risk prediction after acute ST-segment–elevation myocardial infarction. Methods and Results— Patients admitted for a first noncomplicated ST-segment–elevation myocardial infarction were prospectively followed up. A total of 440 patients were included. All of them underwent CMR 1 week after admission. CMR-derived LVEF and IS (grams per meter squared) were quantified. AACEs included postdischarge sudden death, sustained ventricular tachycardia, and ventricular fibrillation either documented on ECG or recorded via an implantable cardioverter-defibrillator. Within a median follow-up of 2 ...
International Heart Journal, 2011
This study evaluated the association between atrial fibrillation (AF) and 30-day clinical outcome in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Between January 2005 and October 2009, 783 consecutive patients with acute STEMI undergoing primary PCI were enrolled. Of these patients, 85 (10.9%) with AF during admission were categorized into group 1, while the remaining 698 (89.1%) with sinus rhythm during admission served as group 2. The results demonstrated that the incidence of advanced Killip score (defined as ≥ score 3) and advanced congestive heart failure (defined as ≥ NYHA class 3) were significantly higher, whereas the left ventricular ejection fraction (LVEF) was notably lower in group 1 than in group 2 (all P < 0.003). Additionally, the normal blood flow in the infarct-related artery was notably lower in group 1 than in group 2 (P = 0.003). Moreover, the incidences of new-onset stroke and 30-day mortality were remarkably higher in group 1 than in group 2 (all P < 0.003). Furthermore, Kaplan-Meier analysis demonstrated that the 30-day survival rate was markedly lower in AF patients than in those with sinus rhythm. However, multivariate stepwise Cox regression analysis demonstrated that the advanced Killip score and low LVEF were significantly and independently predictive of 30day mortality (all P < 0.004). In conclusion, AF was significantly associated with 30-day mortality.
Netherlands Heart Journal, 2012
In patients with ST-segment elevation myocardial infarction (STEMI), it is uncertain whether atrial fibrillation has prognostic implications. There may be a difference between atrial fibrillation before and after reperfusion therapy. In patients with STEMI treated with primary percutaneous coronary intervention (PCI), ECGs were analysed before and after primary PCI. Of the 1623 patients with electrocardiographic data before primary PCI, 53 patients (3.3%) had atrial fibrillation. Patients with atrial fibrillation were older, were more often female, and less often had anterior MI location. Of the 1728 patients with electrocardiographic data after primary PCI, 52 patients (3.0%) had atrial fibrillation. Atrial fibrillation was more common in older patients and in those with Killip class &amp;gt;1. Also patients with occlusion of the right coronary artery or TIMI flow 0 before primary PCI more commonly had AF after the procedure. Not successful reperfusion was also associated with a higher incidence of AF after primary PCI. Although both atrial fibrillation before and after primary PCI were associated with increased mortality, multivariable analyses, adjusting for differences in age, gender and Killip class on admission, revealed that atrial fibrillation after PCI (OR 3.69, 95% CI 1.87-7.29) but not before PCI (OR 1.86, 95% CI 0.89-3.90) was independent and statistically significantly associated with long-term mortality. In patients with STEMI, atrial fibrillation after but not before primary PCI has independent prognostic implications. Possibly, atrial fibrillation after the PCI is a symptom of failed reperfusion and a sign of heart failure.
The American Journal of Cardiology, 2014
Atrial fibrillation (AF) has been associated with worse outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. The aim of this study was to evaluate the incidence and impact of new-onset AF after primary PCI in patients with ST-segment elevation myocardial infarctions from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. HORIZONS-AMI was a large-scale, multicenter, international, randomized trial comparing different antithrombotic regimens and stents during primary PCI in patients with STsegment elevation myocardial infarctions. Three-year ischemic and bleeding end points were compared between patients with and without new-onset AF after PCI. Of the 3,602 patients included in the HORIZONS-AMI study, 3,281 (91.1%) with sinus rhythm at initial presentation had primary PCI as their primary management strategy. Of these, new-onset AF developed in 147 (4.5%). Compared with patients without AF after PCI, patients with new-onset AF had higher 3-year rates of net adverse clinical events (46.5% vs 25.7%, p <0.0001), mortality (11.9% vs 6.3%, p [ 0.01), reinfarction (16.4% vs 7.0%, p <0.0001), stroke (5.8% vs 1.5%, p <0.0001), and major bleeding (20.9% vs 8.2%, p <0.0001). By multivariate analysis, new-onset AF after PCI was a powerful independent predictor of net adverse clinical events (hazard ratio 1.74, 95% confidence interval 1.30 to 2.34, p [ 0.0002) and major adverse cardiac events (hazard ratio 1.73, 95% confidence interval 1.27 to 2.36) at 3 years. In conclusion, new-onset AF after PCI for ST-segment elevation myocardial infarction was associated with markedly higher rates of adverse events and mortality. Ó
2011
Study Population and Design: Acute Atrial Fibrillation (AF) is an important complication of ST Segment Elevation Myocardial Infarction (STEMI) even in the Primary angioplasty era. AF is an independent predictor of both short termand long term mortality. What is the incremental risk of developing complications when AF complicates STEMI? Materials and Methods: It was a single center, prospective cohort study, conducted from October 2014 to January 2016. The patients were divided into three groups. 1. Those with AF at admission. 2. Those developing AF within 24 hours of admission. 3. Those developing AF after 24 hours and till discharge. The patient’s clinical and echocardiographic profile were documented. They were followed up for development of heart failure, arrhythmias, cardiogenic shock, Cerebrovascular Accident (CVA) and death. Results: A total of 118 STEMI patients (59 with AF and 59 without) were included in the study. In-hospital (20.3% vs. 6.8% p= 0.031) and total mortality w...
Journal of Pharmaceutical Research International
Aim: This study aims to find out the incidence of atrial fibrillation new onset in STEMI patients receiving primary PCI Sample: A total of 169 patients have included after sample size calculation by using WHO sample size calculator version 2.0. Study Design: Descriptive cross-sectional study Place and Duration of Study: This study was conducted at the Department of Interventional Cardiology at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan from April 18th, 2020, to October 17, 2020. Methodology: The inclusion criteria set for data collection were as; all the patients undergoing Primary PCI with age between 40 to 80 years, males and females, patients presented with 12 hours of the onset of chest pain with STEMI to enroll in the study. Whereas, patients who had a previous history of any cardiac-related surgery and known AF, also all the patients suffered AF after trial of cardioversion, and those patients who had ejection fraction less than 20% were exclud...
Anatolian journal of cardiology, 2021
OBJECTIVE The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. METHODS A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. RESULTS The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF ...