Abstract 12670: New-Onset AF Increases All-cause Mortality and Cardiovascular Death in a First-time Myocardial Infarction Population - A Nationwide Propensity Score Matched Study
Background: New-onset atrial fibrillation (AF) is associated with a high risk of death in myocardial infarction (MI) patients. However, previous studies report conflict and no data exist on causes of death in MI patients who develop AF.
Methods: All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. All-cause mortality, cardiovascular (CV) death, fatal/non-fatal stroke, fatal/non-fatal re-infarction and non-CV death after new-onset AF in first-time MI patients were analyzed by multivariable time-dependent Cox models adjusted for age, gender, concomitant medication and comorbidity, and additionally in propensity score matched analysis.
Results: 89,703 patients with average follow-up of 5.0±3.5years were analyzed. In the 10,708 patients developing AF after MI, all-cause mortality occurred in 5423 (50.6%), CV death in 4,277 (39.9%), fatal/non-fatal stroke 610 (5.7%)/573 (5.42%), fatal/non-fatal re-infarction 905 (8.5%)/1.521 (16.3%) and non-CV death 1,146 (10.7%). In 78,992 patients without AF, all-cause mortality occurred in 26,885 (34.0%), CV death 19,383 (24.5%), fatal/non-fatal stroke 2,414 (3.1%)/33 (0.1%), fatal/non-fatal re-infarction 5,502 (7.0%)/334 (0.5%) and non-CV death 7.502 (9.5%). Time-dependent multivariable Cox analyses showed significant AF-associated increase in all-cause mortality (HR: 1.9[95%CI: 1.8-2.0]), CV-death (HR: 2.1[2.0-2.2]), fatal/non-fatal stroke (HR: 2.3[2.1-2.6]/ HR: 2.5[2.2-2.7]), fatal/non-fatal re-infarction (HR: 1.7[1.6-1.8]/ (HR: 1.8[1.7-1.9],) and non-CV death (HR: 1.4[1.3-1.5]) all p<0.001. Propensity-score matched analysis yielded nearly identical results (Figure, all p<0.001).
Conclusions: New-onset AF after first-time MI is associated with increased all-cause and CV mortality, and death from stroke and re-infarction. Focus on the prognostic impact of post-infarct AF is warranted.
- © 2012 by American Heart Association, Inc.