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Atrial Fibrillation and Risk of ST-Segment-Elevation Versus Non-ST-Segment-Elevation Myocardial Infarction: The
Elsayed Z Soliman1, Faye Lopez2, Wesley T O'Neal2
1From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (E.Z.S., Z.-M.Z.), Department of Internal Medicine, Section on Cardiology (E.Z.S.), and Department of Internal Medicine (W.T.O.), Wake Forest School of Medicine, Winston Salem, NC; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L., L.B., A.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (L.L.); and Department of Medicine, University of Vermont, Burlington (M.C.). esoliman@wakehealth.edu.
Insights
Atrial fibrillation (AF) increases myocardial infarction (MI) risk, particularly non-ST-segment-elevation MI (NSTEMI), especially in women. This finding highlights potential sex differences in cardiovascular disease mechanisms.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Atrial fibrillation (AF) is linked to a higher risk of myocardial infarction (MI).
- The underlying mechanisms for this association remain unclear.
- Investigating the relationship between AF and specific MI types (STEMI vs. NSTEMI) may offer insights into mechanisms.
Purpose of the Study:
- To examine the association between atrial fibrillation (AF) and incident myocardial infarction (MI).
- To determine if this association differs between ST-segment-elevation MI (STEMI) and non-ST-segment-elevation MI (NSTEMI).
- To explore potential sex differences in the AF-MI relationship.
Main Methods:
- Analysis of 14,462 participants from the Atherosclerosis Risk in Communities (ARIC) study, free of coronary heart disease at baseline.
- Follow-up for incident MI and AF identification through ECGs and hospital records over a median of 21.6 years.
- Multivariable-adjusted Cox proportional hazards models were used to assess associations, with interaction analyses for sex differences.
Main Results:
- Atrial fibrillation (AF) was associated with a 63% increased risk of overall MI.
- The association was significant for non-ST-segment-elevation MI (NSTEMI) but not for ST-segment-elevation MI (STEMI).
- The link between AF and MI (total and NSTEMI) was significantly stronger in women than in men.
Conclusions:
- Atrial fibrillation is associated with an elevated risk of incident myocardial infarction.
- This association is specifically linked to non-ST-segment-elevation MI (NSTEMI).
- Women exhibit a stronger association between AF and MI compared to men.
Background:
It has recently been reported that atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association is currently unknown. Further study of the relationship of AF with the type of MI (ST-segment-elevation MI [STEMI] versus non-ST-segment-elevation MI [NSTEMI]) might shed light on the potential mechanisms.
Methods And Results:
We examined the association between AF and incident MI in 14 462 participants (mean age, 54 years; 56% women; 26% blacks) from the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary heart disease at baseline (1987-1989) with follow-up through December 31, 2010. AF cases were identified from study visit ECGs and by review of hospital discharge records. Incident MI and its types were ascertained by an independent adjudication committee. Over a median follow-up of 21.6 years, 1374 MI events occurred (829 NSTEMIs, 249 STEMIs, 296 unclassifiable MIs). In a multivariable-adjusted model, AF (n=1545) as a time-varying variable was associated with a 63% increased risk of MI (hazard ratio,1.63; 95% confidence interval, 1.32-2.02). However, AF was associated with NSTEMI (hazard ratio, 1.80; 95% confidence interval, 1.39-2.31) but not STEMI (hazard ratio, 0.49; 95% confidence interval, 0.18-1.34; P for hazard ratio comparison=0.004). Combining the unclassifiable MI group with either STEMI or NSTEMI did not change this conclusion. The association between AF and MI, total and NSTEMI, was stronger in women than in men (P for interaction <0.01 for both).
Conclusions:
AF is associated with an increased risk of incident MI, especially in women. However, this association is limited to NSTEMI.
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