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Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction

Kyung-Kuk Hwang1,2, Sang-Yong Eom3, Sang Yeub Lee1

  • 1Chungbuk Regional Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital.

International Heart Journal
|July 11, 2017
PubMed

Insights

Atrial fibrillation (AF) significantly increases 1-year mortality in ST-segment elevation myocardial infarction (STEMI) patients, even after primary PCI. This study highlights AF as a critical prognostic factor in STEMI care.

Area of Science:

  • Cardiology
  • Clinical Research
  • Public Health

Background:

  • Atrial fibrillation (AF) is a common arrhythmia, and its impact on outcomes in ST-segment elevation myocardial infarction (STEMI) requires further clarification.
  • Understanding the prognostic significance of AF in STEMI patients undergoing primary percutaneous coronary intervention (PCI) is crucial for risk stratification and management.

Purpose of the Study:

  • To investigate the association between atrial fibrillation (AF) and 1-year all-cause and cardiac mortality in patients with ST-segment elevation myocardial infarction (STEMI).
  • To determine the prognostic value of AF in STEMI patients who received primary percutaneous coronary intervention (PCI).

Main Methods:

  • Retrospective analysis of the Korea Acute Myocardial Infarction Registry (KAMIR) database (January 2008 - September 2010).
  • Inclusion of 5,556 STEMI patients with normal sinus rhythm (NSR) or AF on ECG, presenting within 12 hours of symptom onset, and undergoing primary PCI within 90 minutes.
  • Follow-up data for 1 year was analyzed for 2,636 NSR patients and 119 AF patients.

Main Results:

  • AF patients were older and presented with lower systolic blood pressure and higher heart rates compared to NSR patients.
  • At 1 year, AF patients exhibited significantly higher all-cause mortality (22.7% vs. 9.5%) and cardiac death rates (17.7% vs. 7.5%) compared to NSR patients.
  • AF was independently associated with a 2.5-fold increased risk of all-cause mortality and cardiac mortality in STEMI patients post-primary PCI.

Conclusions:

  • Atrial fibrillation is a significant independent predictor of increased 1-year all-cause and cardiac mortality in STEMI patients.
  • Even with successful primary PCI, AF confers a substantially worse prognosis in STEMI patients.
  • Risk stratification and intensified management strategies are warranted for STEMI patients presenting with AF.

Keywords:
Major adverse cardiac eventNormal sinus rhythmTarget lesion revascularization

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