Martínez Membrive María José, Subirana Isaac, Fadeuilhe Edgar, Rueda Ferran, Carreras-Mora José, Oliveras Teresa, Giralt Teresa, Labata Carlos, Ferrer Marc, El Ouaddi Nabil, Montero Santiago, Elosúa Roberto, Ribas Núria, Bayés-Genís Antoni, García-García Cosme
Cardiology Department, Hospital del Mar, Paseo Marítimo de la Barceloneta, 25-29, Barcelona 08003, Spain.
Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Eur Heart J Acute Cardiovasc Care. 2025 Apr 26;14(4):214-222. doi: 10.1093/ehjacc/zuae072.
Atrial fibrillation (AF) often complicates ST-elevation acute myocardial infarction (STEMI), with associated risks including stroke and mortality. Anticoagulation therapy for these patients and AF prognosis remain controversial. The aim was to evaluate long-term prognosis of STEMI patients complicated with AF in the acute phase.
We performed a retrospective analysis on a prospective register involving 4184 patients admitted for STEMI to the intensive cardiac care unit of two tertiary centres from 2007 to 2015. Patients with pre-existing permanent AF were excluded. Out of these, 269 (6.4%) patients developed AF within the first 48 h after STEMI and were matched with a control group based on age and left ventricular ejection fraction. After matching, a total of 470 patients were included (n = 235, AF-STEMI; n = 235, control group). Mean age was 69.0 years, and 31.7% were women. No differences were found in gender, cardiovascular risk factors, or ischaemic heart disease. AF-STEMI patients experienced more sustained ventricular tachycardia, advanced atrioventricular block, heart failure, and cardiogenic shock. In-hospital mortality was also higher in AF-STEMI patients (11.9% vs. 7.2%, P = 0.008). After a 10-year follow-up, the AF-STEMI group had remained with higher mortality (50.5% vs. 36.2%; P = 0.003) and a greater recurrence of AF (44.2% vs. 14.7%; P < 0.001), without differences in stroke incidence (10.1% vs. 9.3%).
As a conclusion, patients with AF complicating STEMI have higher rates of heart failure, cardiogenic shock, and in-hospital mortality. After a 10-year follow-up, they exhibit a high risk of AF recurrence and mortality, with no significant differences in stroke incidence.
心房颤动（AF）常使ST段抬高型急性心肌梗死（STEMI）复杂化，相关风险包括中风和死亡。这些患者的抗凝治疗及AF预后仍存在争议。本研究旨在评估急性期并发AF的STEMI患者的长期预后。
我们对2007年至2015年期间在两个三级中心的重症心脏监护病房因STEMI入院的4184例患者的前瞻性登记资料进行了回顾性分析。排除既往有永久性AF的患者。其中，269例（6.4%）患者在STEMI后48小时内发生AF，并根据年龄和左心室射血分数与对照组进行匹配。匹配后，共纳入470例患者（n = 235，AF-STEMI组；n = 235，对照组）。平均年龄为69.0岁，女性占31.7%。在性别、心血管危险因素或缺血性心脏病方面未发现差异。AF-STEMI患者发生持续性室性心动过速、高度房室传导阻滞、心力衰竭和心源性休克的情况更多。AF-STEMI患者的院内死亡率也更高（11.9%对7.2%，P = 0.008）。经过10年随访后，AF-STEMI组的死亡率仍然较高（50.5%对36.2%；P = 0.003），AF复发率更高（44.2%对14.7%；P < 0.001），中风发生率无差异（10.1%对9.3%）。
总之，并发AF的STEMI患者发生心力衰竭、心源性休克和院内死亡的几率更高。经过10年随访，他们表现出AF复发和死亡的高风险，中风发生率无显著差异。
