Minder Judith, Mannhart Diego, Brunner Sarah, Di Bari Gianluca, Knecht Sven, Krisai Philipp, Nestelberger Thomas, Boeddinghaus Jasper, Leibundgut Gregor, Kaiser Christoph, Mueller Christian, Osswald Stefan, Sticherling Christian, Kühne Michael, Badertscher Patrick
Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
J Interv Card Electrophysiol. 2024 Dec 11. doi: 10.1007/s10840-024-01941-5.
New-onset atrial fibrillation (NOAF) complicating ST-segment elevation myocardial infarction (STEMI) remains clinically challenging. The aim of this study was to assess the incidence of NOAF, identify risk factors for the development of atrial fibrillation (AF), and analyze the impact on patient care, therapy, and outcomes during long-term follow-up.
This retrospective single-center study reviewed consecutive patients undergoing coronary angiography (CAG) for acute STEMI between May 2015 and September 2023. Patients were stratified in NOAF, defined as AF diagnosed during the index hospitalization or within 12 months of follow-up, AF prior to the hospitalization for STEMI, and patients with no AF.
We analyzed 1301 consecutive patients undergoing CAG for STEMI. NOAF was detected in 112 patients (9.8%), and 68 patients (5.2%) had prior AF. NOAF patients were 74% males, with a mean age of 69 ± 11 years. During a median follow-up of 683 days, the rates of stroke were 10% in patients with NOAF compared to 3.8% (p = 0.001) in patients without AF. Major bleeding occurred in 7% vs. 1.7%, p = 0.001, and death in 16% vs. 6.8%, p < 0.001 of patients with NOAF vs. no AF.
NOAF was detected in almost 1 out of 10 STEMI patients and was associated with a higher rate of stroke, major bleeding, and death as in patients with no AF and with similar rates compared with prior AF. Future studies assessing optimal anticoagulation therapy in this challenging patient population are warranted.
新发房颤（NOAF）并发ST段抬高型心肌梗死（STEMI）在临床上仍然具有挑战性。本研究的目的是评估NOAF的发生率，确定房颤（AF）发生的危险因素，并分析长期随访期间对患者护理、治疗及预后的影响。
这项回顾性单中心研究纳入了2015年5月至2023年9月期间因急性STEMI接受冠状动脉造影（CAG）的连续患者。患者被分为NOAF组（定义为在首次住院期间或随访12个月内诊断出的AF）、STEMI住院前有AF组以及无AF组。
我们分析了1301例因STEMI接受CAG的连续患者。112例患者（9.8%）检测到NOAF，68例患者（5.2%）既往有AF。NOAF患者中男性占74%，平均年龄为69±11岁。在中位随访683天期间，NOAF患者的卒中发生率为10%，而无AF患者为3.8%（p = 0.001）。NOAF患者大出血发生率为7%，无AF患者为1.7%，p = 0.001；NOAF患者死亡率为16%，无AF患者为6.8%，p < 0.001。
几乎每10例STEMI患者中就有1例检测到NOAF，与无AF患者相比，其卒中、大出血和死亡发生率更高，与既往有AF患者的发生率相似。有必要开展未来研究评估针对这一具有挑战性患者群体的最佳抗凝治疗。
