Transient new-onset AF after AMI increased recurrent AF risk nearly 5-fold (HR 4.97) and raised composite risk of stroke, recurrent AMI, or death by 38% (HR 1.38).
Does transient new-onset atrial fibrillation increase the risk of ischemic stroke, TIA, recurrent AF, and mortality in patients with acute myocardial infarction?
Transient new-onset atrial fibrillation during acute myocardial infarction is a marker of increased long-term risk for recurrent AF and adverse cardiovascular events.
Absolute Event Rate: 0% vs 0%
Abstract Background Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI). In the AMI setting, AF may be brief and attributed to acute hemodynamic changes, inflammation, or ischemia. However, the long-term clinical significance of these transient episodes remains unclear. Purpose To study the impact of transient new-onset AF on the risk of recurrent AF, ischemic stroke or transient ischemic attack (TIA), recurrent AMI, and mortality. Methods We conducted a retrospective cohort study of all patients admitted with AMI to a tertiary center. Patients with pre-existing AF or persistent AF during hospitalization were excluded. The cohort was cross-referenced with a national registry to track outcomes over 3 years from admission. Primary outcome was incidence of ischemic stroke or TIA; secondary outcomes included recurrent AF, and a composite endpoint of recurrent AMI, stroke, or mortality. Hazard ratios (HRs) were estimated by Cox proportional hazards models. Results A cohort of 7,127 patients was included, of whom 202 (2.8%) developed transient new-onset during their index hospitalization. Patients with transient new-onset AF, compared to those without AF, were more likely to be older (69.2 vs. 63 years, p.001), more often female (32.9% vs. 23.0%, p.001), and had higher rates of mitral regurgitation (19.7% vs. 9.4%, .001), moderate-to-severe left atrium enlargement (18.1% vs. 5.1%, p.001) and moderate-to-severe left ventricle enlargement (9.8% vs. 4.7%, p=.01). During the 3-year follow-up, patients with transient new-onset AF had a numerically higher incidence of stroke or TIA (5.0% vs. 3.0%), with a HR of 1.87 (95% CI; 0.98-3.53, p=.054) that did not reach statistical significance. Recurrent AF was significantly higher in these patients (8.46% vs. 2.0%; HR 4.97, 95% CI; 2.99-8.25, p.001). The composite endpoint was also significantly higher among patients with transient new-onset AF (HR 1.38, 95% CI; 1.09-1.76, p=.008), as displayed in Figure 1. Conclusions Transient new-onset AF at the time of AMI is associated with worse clinical outcomes. Specifically, it increases the risk of recurrent AF and a composite endpoint of stroke, recurrent AMI, and mortality. Further research is warranted to improve risk stratification and evaluate optimal management approaches for this high-risk population.Figure 1
Fischman et al. (Sat,) reported a other. Transient new-onset AF after AMI increased recurrent AF risk nearly 5-fold (HR 4.97) and raised composite risk of stroke, recurrent AMI, or death by 38% (HR 1.38).