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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention
Iqra Shakeel1, Harish Sharma1,2, James Hodson3
1College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
Insights
Atrial fibrillation (AF) affects 6.5% of acute myocardial infarction (MI) patients, often linked to coronary artery disease. While initially associated with worse outcomes, AF is not independently linked to major adverse cardiac and cerebrovascular events after adjusting for comorbidities.
Area of Science:
- Cardiology
- Clinical Medicine
- Epidemiology
Background:
- Concomitant atrial fibrillation (AF) in acute myocardial infarction (MI) patients is linked to poor prognosis.
- The independent role of AF versus comorbidities as a cause of adverse outcomes in MI patients remains unclear.
- Impact of coronary artery disease distribution on AF development risk needs further investigation.
Purpose of the Study:
- To investigate the association between AF and major adverse cardiac and cerebrovascular events (MACCEs) in acute MI patients.
- To determine if AF is an independent predictor of MACCEs or a marker of underlying comorbidities.
- To explore the relationship between coronary artery disease distribution and AF in MI patients.
Main Methods:
- Retrospective analysis of consecutive acute MI patients treated with percutaneous coronary intervention (PCI).
- Assessment of AF association with MACCEs using Cox regression, multivariable modeling, and propensity-score matching.
- Long-term follow-up (median 5 years) for MACCEs.
Main Results:
- AF was present in 6.5% of acute MI patients, who were older and had more comorbidities.
- Patients with AF showed a higher propensity for left main stem or left circumflex artery disease.
- Unadjusted MACCE rates were higher in AF patients, but this association disappeared after adjusting for confounding factors.
Conclusions:
- AF is a significant comorbidity in 6.5% of acute MI patients, often associated with complex coronary artery disease.
- The increased risk of MACCEs in AF patients with acute MI is primarily attributed to comorbidities, not AF itself.
- This study found no independent association between AF and long-term MACCEs in acute MI patients after adjusting for confounders.
Abstract:
Background: Concomitant atrial fibrillation (AF) is associated with an adverse prognosis in patients with acute myocardial infarction (MI). However, it remains unclear whether this is due to a causal effect of AF or whether AF acts as a surrogate marker for comorbidities in this population. Furthermore, there are limited data on whether coronary artery disease distribution impacts the risk of developing AF. Methods: Consecutive patients admitted with acute MI and treated using percutaneous coronary intervention (PCI) at a single centre were retrospectively identified. Associations between AF and major adverse cardiac and cerebrovascular events (MACCEs) over a median of five years of follow-up were assessed using Cox regression, with adjustment for confounding factors performed using both multivariable modelling and a propensity-score-matched analysis. Results: AF was identified in N = 65/1000 (6.5%) of cases; these patients were significantly older (mean: 73 vs. 65 years, p < 0.001), with lower creatinine clearance (p < 0.001), and were more likely to have a history of cerebrovascular disease (p = 0.011) than those without AF. In addition, patients with AF had a greater propensity for left main stem (p = 0.001) or left circumflex artery (p = 0.004) involvement. Long-term MACCE rates were significantly higher in the AF group than in the non-AF group (50.8% vs. 34.2% at five years), yielding an unadjusted hazard ratio (HR) of 1.86 (95% CI: 1.32-2.64, p < 0.001). However, after adjustment for confounding factors, AF was no longer independently associated with MACCEs, either on multivariable (adjusted HR: 1.25, 95% CI: 0.81-1.92, p = 0.319) or propensity-score-matched (HR: 1.04, 95% CI: 0.59-1.82, p = 0.886) analyses. Conclusions: AF is observed in 6.5% of patients admitted with acute MI, and those with AF are more likely to have significant diseases involving left main or circumflex arteries. Although unadjusted MACCE rates were significantly higher in patients with AF, this effect was not found to remain significant after adjustment for comorbidities. As such, this study provided no evidence to suggest that AF is independently associated with MACCEs.
