Cosentino Nicola, Ballarotto Marco, Campodonico Jeness, Milazzo Valentina, Bonomi Alice, Genovesi Simonetta, Moltrasio Marco, De Metrio Monica, Rubino Mara, Veglia Fabrizio, Assanelli Emilio, Marana Ivana, Grazi Marco, Lauri Gianfranco, Bartorelli Antonio L, Marenzi Giancarlo
Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
Nephrology Unit, San Gerardo Hospital, University of Milan-Bicocca, 20100 Milan, Italy.
J Clin Med. 2020 May 9;9(5):1396. doi: 10.3390/jcm9051396.
Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated.
We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 ( = 1887): GFR >60; group 2 ( = 492): GFR 60-30; group 3 ( = 66): GFR <30 mL/min/1.73 m). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints.
The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively ( < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; < 0.0001) and long-term (34% vs. 13%; < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders.
This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission.
心房颤动（AF）是急性心肌梗死（AMI）常见的并发症，且与较差的预后相关。慢性肾脏病患者更易发生AF。AF与肾小球滤过率（GFR）之间的关联在AMI患者中是否成立尚未得到研究。
我们前瞻性纳入了2445例AMI患者。记录住院期间新发AF情况。入院时估算GFR，并根据GFR将患者分组（第1组（n = 1887）：GFR>60；第2组（n = 492）：GFR 60 - 30；第3组（n = 66）：GFR<30 mL/min/1.73 m²）。主要终点为AF发生率。住院期间及长期（中位时间5年）死亡率为次要终点。
总体人群中AF发生率为10%，第1、2、3组分别为8%、16%、24%（P<0.0001）。在总体人群中，AF与较高的住院期间死亡率（5%对1%；P<0.0001）和长期死亡率（34%对13%；P<0.0001）相关。在每个研究组中，AF患者的住院期间死亡率更高（分别为3.5%对0.5%，6.5%对3.0%，19%对8%；P<0.0001）。三组长期死亡率也观察到类似趋势（20%对9%，51%对24%，81%对50%；P<0.0001）。在对主要混杂因素进行校正后，每组中AF相关的住院期间及长期死亡风险更高得到证实。
本研究表明，AMI期间新发AF的发生率以及相关的住院期间和长期死亡率，与入院时评估的GFR降低呈平行增加。
