| Authors |
N |
Population |
AF Incidence |
Risk Factors for AF |
Outcomes |
| Siu et al[2] |
431 |
Inferior STEMI patients with preserved LV function Mean age 64±1 y |
Transient in-hospital AF-13.7% |
Older age, women |
1 year incidence of AF and stroke higher but mortality similar in comparison to group without AF |
| Bahouth et al[3] |
1920 |
Acute MI patients without known AF |
New-onset AF in 8.4% |
FMR, impaired LVEF<45%, Killip class>1, age=60y, enlarged left atrium |
New onset AF did not independently predict mortality after adjustment for functional mitral regurgitation(FMR) and LV ejection fraction |
| Wong et al (GUSTO III trial investigators)[5] |
13,858 |
Acute STEMI/LBBB patients randomised to alteplase or reteplase |
New-onset AF -6.5% |
Age, systolic BP(SBP), weIght, Killip class, previous bypass, complete heart block, ventricular fibrillation |
AF independently predicted in-hospital, 30day and 1 year adverse mortality |
| Rathore et al[6] |
106,780 |
Acute MI patients aged =65y |
11.3% new-onset AF |
Killip class 4, heart rate , SBP,age, anterior MI, race, previous MI/ cerebrovascular disease, hypertension, time to presentation, current smoking status |
New onset AF independently predicted increased in-hospital , 30 day and 1 year mortality |
| Pizzetti et al (GISSI-3 investigators)[7] |
17,749 |
Acute MI patients (without chronic AF) randomised to lisinopril or no lisinopril |
7.8% new-onset AF |
Age, Killip class, heart rate, previous MI, hypertension, diabetes, females, lack of thrombolysis, LVEF |
AF independently predicts worse in-hospital and long-term mortality Late-onset AF (after days 0-1) predicted hospital mortality but no long-term mortality |
| Pedersen et al (TRACE Study investigators)[8] |
6676 |
Acute MI patients randomised to trandalopril |
5.3% new-onset AF |
Age, LVEF, lack of thrombolysis, males, hypertension |
AF predicts worse in-hospital and long-term mortality in patients with heart failure |
| Mcmurray et al (CAPRCORN Trial investigators)[10] |
984placebo,975 carvedilol |
Acute MI patients, post-hoc analysis of arrhythmias |
New-onset AF 5.4 % in placebo group and 2.3% in carvedilol group |
|
Carvedilol treatment significantly reduces risk of post-MI AF |
| Danchin[12] |
3396 |
Acute MI patients without AF on first ECG |
New-onset AF -4.7% |
Older age, later statin therapy, higher GRACE score, previous nitrate use, use of loop diuretics during 1st 48h |
Early statin therapy led to reduced risk of developing AF |
| Mrdovic (RISK-PCI Trial)[13] |
2096 |
Primary PCI patients |
New onset AF 6.2% |
Older age, Killip>1, systolic BP, creatinine clearance, post-procedural TIMI flow<3 |
AF independently predicts worse 30 day MACE and mortality |
| Kinjo et al[14] |
2475 |
Acute MI patients (Angioplasty <24 hours) |
7.7% developed in-hospital AF AF on admission 4.3% |
Older age, previous MI or cerebrovascular disease, Killip class 4, male gender,SBP<100 mm Hg Heart Rate>100/mt, multi-vessel disease,poorer reperfusion of infarct-related artery |
AF independent predictor of 1 year but not in-hospital mortality |
| Lopes et al (APEX-MI investigators)[15] |
5466 |
Primary PCI patients |
New onset AF 6.3% |
Older, female, lower systolic and diastolic BP, Killip Class 3 and 4, anterior MI, previous heart failure, diabetes, stroke hypertension, higher CK, troponin and BNP |
AF independently associated with adverse 90 day mortality, stroke and heart failure.45% AF patients anti-coagulated at discharge including only 39% of those with CHADS2=2Warfarin use led to lower 90day mortality and strokeTriple therapy led to significantly lower 90day mortality and stroke |
| Beukema[18] |
1728 |
Primary PCI |
AF post-primary PCI 3% |
Older, Killip>1, right coronary artery occlusion, TIMI flow 0 before procedure, unsuccessful reperfusion |
Only post-primary PCI AF independently predicted worse long-term mortality |
| Podolecki et al[19] |
2980 |
Acute MI patients treated invasively |
Overall AF incidence of 9.46% (pre-hospital only AF -3.09%; new-onset AF-3.66%; permanent AF -2.72%) |
Older age, diabetes, impaired renal function, severely impaired LV EF |
Only permanent AF and new-onset AF predicted short and long term mortality |
| Kober et al (from the VALIANT Trial investigators)[20] |
14703 |
Acute MI patients with clinical or radiological signs of heart failure, reduced LV systolic function or both |
New-onset AF 12.3% |
Older age, higher body mass index, heart rate, SBP, Killip class>1, NSTEMI, renal impairment |
Both current and prior AF independently predicted worse long term mortality and major cardiovascular events, magnitude of risk prediction for adverse outcomes similar between these 2 groups |
| Sankaranarayanan et al[35] |
500 |
Acute MI patients |
New-onset AF 11.4% |
Older age, LVEF, smoking status |
Both AF on admission and new-onset AF predicted increased in-hospital, 1 year and 5.5 year mortality. Only AF on admission was independently associated with VF. |
| Li et al[37] |
967 |
Acute MI patients aged =65 years |
New-onset AF 6.51% |
Previous MI, cerebrovascular disease, circumflex disease, Killip class 3,4, NSTEMI, inferior MI |
AF did not independently predict in-hospital mortality |
| Bishara et al[47] |
2402 |
Acute MI patients |
Transient new-onset AF 7.2% |
|
Transient AF predicted high recurrence rate and risk of stroke or TIA over 1 year |
| Studies Including Post-Discharge AF |
|
|
|
|
|
| Lehto et al (OPTIMAAL investigators)[11] |
4822 |
Acute MI patients with clinical heart failure or LVEF<40% |
New AF -2% during 1st 3 months and 7.2% overall during median follow-up 3 years |
Older age, male, Killip class, diastolic BP, heart rate, history of angina |
New-onset AF predicts increased 30 day mortality and stroke as well as long term mortality |
| Jabre et al[31] |
3220 |
Acute MI patients |
New-onset AF 22.6% over a 6.6 year mean follow-up |
Older age, female sex, hypertension, diabetes, renal impairment, anterior MI, lower LVEF, higher Killip class |
AF independently predicts adverse outcome (and the highest risk is due to AF occurring>30 days post-MI |
| Jons et al (CARISMA study investigators)[36] |
271 |
Post-MI patients with LVEF=40% and implantable cardiac monitor |
New-onset AF 39.3% during 2 year follow-up |
|
New-onset AF independently predicted major adverse cardiovascular events |
