Raczkowska-Golanko Monika, Młodziński Krzysztof, Raczak Grzegorz, Gruchała Marcin, Daniłowicz-Szymanowicz Ludmiła
Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-211 Gdańsk, Poland.
First Department of Cardiology, Medical University of Gdańsk, 80-211 Gdańsk, Poland.
J Clin Med. 2022 Jul 28;11(15):4410. doi: 10.3390/jcm11154410.
(1) Background: Atrial fibrillation (AF) in acute myocardial infarction (AMI) could worsen the prognosis. Yet, there is no definitive answer to whether new-onset AF (NOAF) is a more aggravating diagnosis than other types of that arrhythmia. The purpose of our study was to compare in-hospital clinical course and outcomes of NOAF patients contrary to patients with other pre-existing types of AF. (2) Methods: AMI patients hospitalized in the high-volume cardiological center within 2017−2018 were included in the study. NOAF was noticed in 106 (11%) patients, 95 (10%) with an AF history and AF during AMI formed the AF group, 60 (6%) with an AF history but without AF during AMI constituted the Prior-AF group, and 693 (73%) patients were without an AF before and during AMI. Medical history, routinely monitored clinical parameters, and in-hospital outcomes were analyzed between the groups. (3) Results: NOAF patients, contrary to others, initially had the highest high-sensitivity troponin I (hsTnI), B-type natriuretic peptide (BNP), C-reactive protein (CRP), and glucose levels, and the lowest potassium concentration, with the worst profile of changes for that parameter within the first four days of hospitalization. NOAF patients had the highest rate of ST-elevated AMI (40%), the longest hospitalization (p < 0.001), and the highest in-hospital mortality (p < 0.001). Not NOAF, but other AF groups (AF and Prior-AF groups) were more burdened with the previous comorbidities. (4) Conclusions: NOAF could be a distinct phenomenon in AMI patients, identifying those with the worst clinical in-hospital course and outcomes as compared to other types of AF.
（1）背景：急性心肌梗死（AMI）合并心房颤动（AF）会使预后恶化。然而，对于新发房颤（NOAF）是否比其他类型的心律失常诊断更严重，尚无定论。我们研究的目的是比较NOAF患者与其他既往存在房颤类型患者的住院临床过程和结局。（2）方法：纳入2017 - 2018年在大型心脏病中心住院的AMI患者。106例（11%）患者出现NOAF，95例（10%）有房颤病史且在AMI期间发生房颤的患者组成房颤组，60例（6%）有房颤病史但在AMI期间未发生房颤的患者构成既往房颤组，693例（73%）患者在AMI前后均无房颤。分析各组之间的病史、常规监测的临床参数和住院结局。（3）结果：与其他患者相比，NOAF患者最初的高敏肌钙蛋白I（hsTnI）、B型利钠肽（BNP）、C反应蛋白（CRP）和血糖水平最高，钾浓度最低，且该参数在住院前四天的变化情况最差。NOAF患者ST段抬高型AMI的发生率最高（40%），住院时间最长（p < 0.001），院内死亡率最高（p < 0.001）。既往合并症负担较重的不是NOAF患者，而是其他房颤组（房颤组和既往房颤组）。（4）结论：NOAF可能是AMI患者中的一种独特现象，与其他类型的房颤相比，其住院临床过程和结局最差。
