Table 2 |.
Studies on the prevention of AF in patients with MI and vice versa
| Study (year) | Number of patients | Patient and study characteristics | Exposures or interventions | Outcomes | Main findings | Refs |
|---|---|---|---|---|---|---|
| Prevention of MI in patients with AF | ||||||
| Connolly et al. (2006) | 6,706 (34% women) | Mean age: 70.2 ± 9.4 years RCT Follow up: 1.28 years |
OAC or clopidogrel plus aspirin | Composite (MI, stroke, embolus, vascular death), MI | Higher risk of composite end point with clopidogrel plus aspirin than with OAC (HR 1.44, 95% CI 1.18–1.76); no significant difference in the risk of MI alone between groups (HR 1.58, 95% CI 0.94–2.67) | 148 |
| Lee et al. (2017) | 71,959 (47% women) | Median age: 75 years Retrospective cohort study Follow up: 4.1 years |
Aspirin monotherapy, VKA monotherapy or dual therapy | First-time MI | Higher risk of MI with aspirin monotherapy than with VKA monotherapy (IRR 1.54, 95% CI 1.40–1.68); higher risk of MI with dual therapy than with VKA monotherapy (IRR 1.22, 95% CI 1.06–1.40) | 115 |
| Lee et al. (2018) | 31,739 (47% women) | Median age: 74 years Retrospective cohort study Follow up: 3 years |
Apixaban, dabigatran, rivaroxaban or VKA | MI | Standardized absolute 1-year risk of MI with apixaban 1.16% (95% CI 0.94–1.39%), dabigatran 1.20% (95% CI 0.95–1.47%), rivaroxaban 1.07% (95% CI 0.83–1.32%) and VKA 1.56% (95% CI 1.33–1.80%); no significant difference in the risk of MI between DOACs; higher risk of MI with VKA than with any of the three DOACs | 119 |
| Vemulapalli et al. (2019) | 10,098 (42% women) | Mean age 73.5±11 years Prospective cohort study Follow up: 2 years |
Changes in systolic blood pressure | MI | Risk of MI increased by 5% (HR 1.05, 95% CI 1.00–1.11) for every 5-mmHg increase in systolic blood pressure from baseline | 120 |
| Prevention of AF in patients with MI | ||||||
| Pedersen et al. (1999) | 1,577 (28% women) | Mean age: 68 years Reduced LVEF RCT Follow up: 4 years |
ACEi versus placebo | New-onset AF | AF in ACEi group: 2.8%; AF in placebo group: 5.3%; lower risk of AF with ACEi than with placebo (HR 0.45, 95% CI 0.26–0.76) | 123 |
| Batra et al. (2017) | 112,648 (35.5% women) | Median age: 72 years (Q1–Q3 62–81) Retrospective cohort study Follow up: 3 years |
ACEi or ARB | New-onset AF | No reduction in the risk of new-onset AF with ACEi or ARB (HR 1.07, 95% CI 1.00–1.15) | 124 |
| Singh et al. (2012) | 28,620 (72.9% women) | Mean age: 78.3 ± 7.1 years Retrospective cohort study Mean follow up: 3.8 years |
ACEi or ARB | New-onset AF | No reduction in risk of new-onset AF with ACEi or ARB (HR 0.99, 95% CI 0.94–1.04) | 125 |
| McMurray et al. (2005) | 1,959 (26% women) | Mean age: 63 years (range: 25–90 years) RCT Follow up: 1.3 years |
β-Blocker versus placebo | AF | AF in β-blocker group: 2.3%; AF in placebo group: 5.4%; lower risk of AF with β-blocker than with placebo (HR 0.41, 95% CI 0.25–0.68) | 126 |
AF, atrial fibrillation; ACEi, angiotensin-converting-enzyme inhibitor; ARB, angiotensin-receptor blocker; DOAC, direct oral anticoagulant; Q1–Q3, 25th to 75th percentiles; IRR, incidence rate ratio; LVEF, left ventricular ejection fraction; MI, myocardial infarction; OAC, oral anticoagulant; RCT, randomized controlled trial; VKA, vitamin K antagonist.