Abstract 2488: Atrial Fibrillation in Acute Myocardial Infarction Increases the Long-term Risk of Sudden Death: Results From 10-year Follow-up
Background: Atrial Fibrillation/Flutter (AF/FL) during Acute Myocardial Infarction (AMI) is known to affect negatively prognosis but few data are available for long-term mortality. Our purpose was to investigate the relationship between presence of AF/FL during AMI and long-term mortality and modes of death.
Methods: This is an analysis of a prospective study in 505 patients enrolled in three Intensive Care Units with definite AMI. All them (but 3 for incomplete data, n=502) completed 10 years of follow up. Continuous 24/h electrocardiographic monitoring was available during the 7 days of hospital stay for all patients. Multivariable analysis was made with Cox regression analysis and logistic polynomial regressions. Patients with persistent or new-onset AF/FL during the 1st week of hospitalization [n=64, median age(IQ) 75(67–82) years, females 39%] were compared with those having steady sinus rhythm [n=438, median age(IQ) 67(58–74) years, females 27%]. End points were all-cause mortality and modes of death.
Results: After 10-year follow-up, 48% of those in sinus rhythm and 81% of those in AF/FL (p<0.0001) had died (12% for sudden death, 30% for non-sudden CV and 11% for non-CV causes). After fully adjustment, AF/FL was not associated to in-hospital mortality. After 10 years of follow-up, presence of AF/FL was associated to all-cause mortality both at univariable level (OR=2.4; 95%CL=1.6–3.3; p<0.0001), and after fully adjustment (OR =1.6; 95%CL=1.1–2.2; p=0.02), together with age, diabetes mellitus, CK-MB peak, presence of heart failure, estimated glomerular filtration rate, and thrombolysis. AF/FL resulted associated to an excess of mortality due to sudden death (SD) (adjusted OR=2.7; 95%CL=1.3–5.5; p=0.008), while no independent association was found for non-sudden-CV mortality and non-CV mortality. Even including in the multivariable models left ventricular ejection fraction (LVEF) (n=402), AF/FL resulted associated to all-cause mortality (OR=2.4; 95%CL=1.1–5–7; p=0.04) and to SD (OR=2.6; 95%CL=1.2–6.5 p=0.03).
Conclusion: AF/FL FL during AMI is associated to increased 10-year mortality. The excess mortality appears chiefly due to sudden death, independently from counfounders and LVEF.