Abstract 19145: The Effect of Atrial Fibrillation on In-Hospital Mortality in Patients With Acute Myocardial Infarction
Background: Atrial fibrillation (AF) has been shown in multiple observational studies to be associated with increased long-term mortality. The effect of AF on short-term outcomes in patients with acute myocardial infarction (AMI) is not clearly defined. We sought to investigate the in-hospital mortality among patient with and without AF presenting with acute myocardial infarction.
Methods: We queried the Nationwide Inpatient Sample (NIS) database from 2008 to 2010. Using the SPSS data analysis package, we identified 374148 adult patients presenting with AMI, both ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). Among those, 58031 had a diagnosis of AF. Fisher exact test was used to compare mortality amongst patients with and without AF. Logistic regression analysis was performed to adjust for pertinent clinical variables.
Results: Patients with AF were older ((x ) - 76.1 yrs. σ 11.8,) compared to those without AF ((x ) - 68.4 yrs. σ 14.5) p<0.001. The proportion of male was higher in the AF group (55.7% vs. 44.3%, p<0.001), as well as the frequency of shock (7.2% vs. 4.9%, p<0.001), CKD (20.3% vs. 12.6%, p<0.001), ESRD (3.8% vs 3.1% p<0.001), Diabetes Mellitus (33.9% vs 33.4% p<0.016), and need for transfusion (11.3% vs 6.9% p<0.001). Patients with AF were less obese (8.7% vs 11.3% p<0.001) and were more likely to be admitted with NSTEMI (74% vs 64.6% p<0.001) and undergo CABG (13.7% vs 7.9% p<0.001). They were less likely to undergo LHC (51.8% vs 67.7%) or be revascularized with PCI (26.7% vs 47% p<0.001) compared to those without AF. Patients with AF and AMI had a longer length of stay (x - 6.4 vs x - 4.6 days). The in-hospital mortality rate for patients with AF and AMI was 8.5%, compared to 4.3% in patients without AF (p<0.001). After adjusting for pertinent clinical and procedural variables using logistic regression analysis, AF remained an independent predictor of higher in-hospital mortality (p<0.001, OR 1.09[1.05-1.13]).
Conclusions: In patients presenting with AMI, AF is associated with a higher incidence of NSTEMI, lower rates of revascularization via PCI, longer hospital LOS and higher in-hospital mortality rates than non AF patients.
- © 2013 by American Heart Association, Inc.