Munther K. Homoud, MD
In patients hospitalized with a first myocardial infarction (MI), is atrial fibrillation (AF) associated with increased risk for mortality? Does timing of AF affect risk for mortality?
Inception cohort followed for a mean 6.6 years.
Rochester Epidemiology Project medical records linkage system in Olmsted County, Minnesota, USA.
3220 patients ≥ 18 years of age (mean age 68 y, 58% men) who were hospitalized with a first MI between 1983 and 2007. An additional 7 patients did not have data for diagnosis of AF and were excluded.
AF (including atrial flutter), age, sex, heart failure, and comorbid conditions (Charlson index).
All-cause and cardiovascular (CV) mortality, and AF.
9.4% of patients had AF before MI, 23% developed AF at or after MI (6.8% ≤ 2 d after MI, 3.7% 3 to 30 d after MI, and 12% > 30 d after MI), and 68% did not develop AF during follow-up. 51% of patients died. Incidence of AF at or after MI was 42 per 1000 person-years of follow-up. AF before or after MI was associated with increased risk for overall mortality; risk was greatest in patients who developed AF > 30 days after MI (Table). Among patients who survived > 30 days after MI, risks for all-cause and CV mortality were similar to that for overall mortality in all patients (Table).
In patients hospitalized with a first myocardial infarction (MI), previous or new-onset atrial fibrillation (AF) was associated with increased risk for mortality; risk was greatest in patients who developed AF > 30 days after MI.
Risk for mortality associated with AF in patients hospitalized with a first MI*
*AF = atrial fibrillation; CV = cardiovascular; HR = hazard ratio; MI = myocardial infarction; CI defined in Glossary.
†Adjusted for age, sex, comorbid conditions (Charlson index), and heart failure. Reference group = patients without AF. HR > 1 indicates increased risk associated with AF.
Homoud MK. Atrial fibrillation before or after incident MI was associated with increased risk for mortality. Ann Intern Med. ;155:JC3–13. doi: 10.7326/0003-4819-155-6-201109200-02013
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Published: Ann Intern Med. 2011;155(6):JC3-13.
Cardiology, Rhythm Disorders and Devices.
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