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New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And
Kisa Hyde Congo1, Adriana Belo2, João Carvalho1
1Hospital Espírito Santo de Évora, Évora - Portugal.
Insights
New-onset atrial fibrillation is a common complication of ST-segment elevation myocardial infarction, increasing in-hospital mortality and complications. Age, prior stroke, inferior myocardial infarction, and complete atrioventricular block predict its development.
Area of Science:
- Cardiology
- Clinical Medicine
- Epidemiology
Background:
- New-onset atrial fibrillation complicates ST-segment elevation myocardial infarction (STEMI), posing significant prognostic challenges.
- Understanding its incidence and predictors is crucial for patient management.
Purpose of the Study:
- To determine the incidence of new-onset atrial fibrillation in STEMI patients.
- To assess its impact on in-hospital therapy and mortality.
- To identify independent predictors for its development during hospitalization.
Main Methods:
- Analysis of a Portuguese national registry of 6325 STEMI patients (2010-2017).
- Comparison between patients with and without new-onset atrial fibrillation.
- Logistic regression modeling to identify predictors and assess mortality impact.
Main Results:
- New-onset atrial fibrillation occurred in 5.8% of patients (365 cases).
- Associated with increased in-hospital complications and mortality, but not an independent predictor.
- Therapy with beta-blockers and ACE inhibitors/ARBs was less frequent; 20.6% received anticoagulation at discharge.
Conclusions:
- New-onset atrial fibrillation is a frequent STEMI complication linked to higher mortality and complications.
- Independent predictors include age, prior stroke, inferior MI, and complete atrioventricular block.
- Anticoagulation at discharge was underutilized (36.7% of relevant patients).
Backgrund:
New-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge, with prognostic significance.
Objective:
To study the incidence, impact on therapy and mortality, and to identify predictors of development of new-onset atrial fibrillation during hospital stay for ST-segment elevation myocardial infarction.
Methods:
We studied all patients with ST-elevation myocardial infarction included consecutively, between 2010 and 2017, in a Portuguese national registry and compared two groups: 1 - no atrial fibrillation and 2 - new-onset atrial fibrillation. We adjusted a logistic regression model data analysis to assess the impact of new-onset atrial fibrillation on in-hospital mortality and to identify independent predictors of its development. A p value < 0.05 was considered significant.
Results:
We studied 6325 patients, and new-onset atrial fibrillation was found in 365 (5.8%). Reperfusion was successfully accomplished in both groups with no difference regarding type of reperfusion. In group 2, therapy with beta-blockers and angiotensin-conversion enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) was less frequent, 20.6% received anticoagulation at discharge and 16.1% were on triple therapy. New-onset atrial fibrillation was associated with more in-hospital complications and mortality. However, it was not found as an independent predictor of in-hospital mortality. We identified age, prior stroke, inferior myocardial infarction and complete atrioventricular block as independent predictors of new-onset atrial fibrillation.
Conclusion:
New-onset atrial fibrillation remains a frequent complication of myocardial infarction and is associated with higher rate of complications and in-hospital mortality. Age, prior stroke, inferior myocardial infarction and complete atrioventricular block were independent predictors of new onset atrial fibrillation. Only 36.7% of the patients received anticoagulation at discharge.
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