Institut MitoVasc, Université d'Angers, Service de Cardiologie, CHU d'Angers, Angers, France.
Institut MitoVasc, Université d'Angers, Service de Cardiologie, CHU d'Angers, Angers, France; Département de Médecine Physique et de Réadaptation, CHU Angers - Les Capucins, Angers, France.
J Cardiol. 2019 Aug;74(2):123-129. doi: 10.1016/j.jjcc.2019.02.004. Epub 2019 May 10.
Atrial fibrillation (AF) is common in ST-segment elevation myocardial infarction (STEMI), but its influence on prognosis remains controversial.
We examined the 1-year prognostic value of AF in STEMI, distinguishing patients with prior AF from patients with de novo AF.
Between January 2004 and December 2015, 3173 STEMI patients were enrolled in the RIMA registry (Registre des Infarctus en Maine Anjou). They were divided into 3 groups: (1) AF-free patients; (2) patients with known prior AF; and (3) patients with de novo AF during hospitalization (including admission). We defined 3 primary outcomes at 1-year post-discharge: cardiovascular mortality, readmission for heart failure (HF), and stroke. Temporal onset of de novo AF was also studied.
A total 158 patients (5%) had prior AF, and 278 (8.8%) presented de novo AF. Prior AF patients were significantly older [81 (73;86) years] with more comorbidities, but de novo AF patients presented with a greater creatine kinase peak and lower left ventricular ejection fraction [LVEF=44 (35;50)% for de novo AF vs 50 (40;55)% for prior AF, p<0.001]. At 1-year follow-up, cardiovascular mortality was higher in cases of AF (13.5% for prior AF vs 9.2% for de novo AF, compared with 2.4% for AF-free patients, p<0.001). After adjustments, only de novo AF was correlated with cardiovascular mortality (hazard ratio 2.49; 95% CI 1.32-4.67; p=0.004), but both types of AF were correlated with readmission for HF. There was no significant difference in respect of stroke between prior AF, de novo AF, and AF-free (2.2%, 0.5%, and 0.8%, respectively, p=0.327). Finally, outcomes did not differ between AF occurring <24h after admission (n=127) and de novo AF occurring within ≥24h (n=151).
De novo AF was independently associated with 1-year cardiovascular mortality. It should not be considered as an intercurrent event of STEMI, but rather as a strong prognostic marker.
心房颤动（AF）在 ST 段抬高型心肌梗死（STEMI）中很常见，但它对预后的影响仍存在争议。
我们研究了 AF 在 STEMI 中的 1 年预后价值，并区分了有既往 AF 病史和新发 AF 病史的患者。
2004 年 1 月至 2015 年 12 月，3173 例 STEMI 患者纳入 RIMA 登记研究（Registre des Infarctus en Maine Anjou）。他们被分为 3 组：（1）无 AF 组；（2）有既往 AF 病史组；（3）住院期间新发 AF 组（包括入院时）。我们在出院后 1 年定义了 3 个主要结局：心血管死亡率、心力衰竭（HF）再入院和卒中。还研究了新发 AF 的时间发生。
共有 158 例患者（5%）有既往 AF，278 例（8.8%）患者发生新发 AF。既往 AF 患者年龄明显较大[81（73；86）岁]，合并症更多，但新发 AF 患者的肌酸激酶峰值更高，左心室射血分数（LVEF）更低[新发 AF 组为 44（35；50）%，而既往 AF 组为 50（40；55）%，p<0.001]。随访 1 年时，AF 患者的心血管死亡率更高（既往 AF 组为 13.5%，新发 AF 组为 9.2%，无 AF 组为 2.4%，p<0.001）。经调整后，只有新发 AF 与心血管死亡率相关（风险比 2.49；95%CI 1.32-4.67；p=0.004），但两种类型的 AF 均与 HF 再入院相关。既往 AF、新发 AF 和无 AF 患者的卒中发生率无显著差异（分别为 2.2%、0.5%和 0.8%，p=0.327）。最后，发生在入院后 24 小时内（n=127）的 AF 与发生在≥24 小时内的新发 AF（n=151）之间的结局无差异。
新发 AF 与 1 年心血管死亡率独立相关。它不应被视为 STEMI 的偶然事件，而应被视为一个强有力的预后标志物。
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