Impact of Atrial Fibrillation During ST-Segment-Elevation Myocardial Infarction on Infarct Characteristics and Prognosis
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Updated: Feb 15, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Sebastian J Reinstadler1, Thomas Stiermaier1, Charlotte Eitel1
1From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical Trial Center Leipzig, University of Leipzig, Germany (M.M.); and Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Germany (S.d.W., S.D., H.T.).
Insights
Atrial fibrillation (AF) in ST-segment-elevation myocardial infarction patients did not alter infarct size or myocardial salvage. However, AF was linked to reduced cardiac function and increased major adverse cardiac events.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Research
Background:
- Atrial fibrillation (AF) is common in ST-segment-elevation myocardial infarction (STEMI) patients.
- AF presence in STEMI is linked to poorer clinical outcomes.
- Mechanisms behind AF's increased risk in STEMI are not fully understood.
Purpose of the Study:
- To investigate the relationship between AF and cardiac magnetic resonance (CMR) derived myocardial salvage and damage in STEMI patients.
- To assess the impact of AF on clinical outcomes post-STEMI.
Main Methods:
- Multicenter study of 786 STEMI patients using cardiac magnetic resonance (CMR).
- Assessed infarct size, myocardial salvage index, microvascular obstruction, and cardiac function 3 days post-STEMI.
- Compared CMR parameters and 12-month major adverse cardiac events (MACE) between patients with and without AF.
Main Results:
- No significant differences in infarct size, myocardial salvage index, or microvascular obstruction between AF and non-AF groups.
- Patients with AF showed significantly lower left ventricular and left atrial ejection fraction.
- AF was independently associated with MACE (all-cause death, reinfarction, congestive heart failure) after adjusting for risk factors and CMR markers.
Conclusions:
- In STEMI patients, AF is not associated with differences in myocardial salvage, infarct size, or microvascular damage.
- AF is linked to cardiac dysfunction (reduced ejection fraction).
- AF independently predicts adverse clinical outcomes in STEMI patients.
Background:
Atrial fibrillation (AF) is frequently observed in patients with ST-segment-elevation myocardial infarction and associated with worse clinical outcome. However, the mechanisms for this increased risk are not fully understood. The purpose of this study was to investigate the relationship of the presence of AF to cardiac magnetic resonance (CMR) derived myocardial salvage and damage as well as clinical outcomes.
Methods And Results:
This multicenter CMR study enrolled 786 patients with ST-segment-elevation myocardial infarction. CMR parameters (infarct size, myocardial salvage index, microvascular obstruction, and myocardial function) were assessed 3 (interquartile range [IQR], 2-4) days post-ST-segment-elevation myocardial infarction and compared between patients with or without AF during hospitalization. Major adverse cardiac events were assessed as a composite of all-cause death, reinfarction, and new congestive heart failure at 12 months. AF was documented in 48 (6.1%) patients. There was no significant difference in infarct size (18 [IQR, 9-29]% versus 17 [IQR, 9-25]% of left ventricular mass; P=0.340), myocardial salvage index (51 [IQR, 34-69] versus 51 [IQR, 33-69]; P=0.830), or microvascular obstruction (0.6 [IQR, 0-2.0]% versus 0.0 [IQR, 0-1.8]% of left ventricular mass; P=0.340) between groups. Patients with AF had significantly lower left ventricular (47 [IQR, 34-54]% versus 51 [IQR, 44-58]%; P=0.003) and left atrial (42 [IQR, 17-57]% versus 53 [IQR, 45-59]%; P<0.001) ejection fraction. AF was associated with major adverse cardiac events, even when adjusting for clinical risk factors (odds ratio, 2.48 [95% confidence interval, 1.22-5.03]; P=0.0120) or CMR prognosis markers (odds ratio, 3.77 [95% confidence interval, 1.83-7.79]; P=0.001).
Conclusions:
This CMR study found no major differences in myocardial salvage, infarct size, or microvascular damage in patients with ST-segment-elevation myocardial infarction or without AF. AF was, however, associated with cardiac dysfunction and independently related to major adverse cardiac events.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00712101.
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