Implications of new-onset atrial fibrillation on in-hospital and long-term prognosis of patients with acute myocardial infarction: A report from the CBD bank study

Wang-Yang Yang; Gregory Y H Lip; Zhi-Jun Sun; Hui Peng; Ameenathul M Fawzy; Hong-Wei Li; Cardiovascular Center Beijing Friendship Hospital Database Bank (CBD Bank) study group

doi:10.3389/fcvm.2022.979546

Implications of new-onset atrial fibrillation on in-hospital and long-term prognosis of patients with acute myocardial infarction: A report from the CBD bank study

Front Cardiovasc Med. 2022 Oct 28:9:979546. doi: 10.3389/fcvm.2022.979546. eCollection 2022.

Authors

Wang-Yang Yang¹, Gregory Y H Lip^{2

3}, Zhi-Jun Sun¹, Hui Peng¹, Ameenathul M Fawzy², Hong-Wei Li¹; Cardiovascular Center Beijing Friendship Hospital Database Bank (CBD Bank) study group

Affiliations

¹ Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
² Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
³ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

Background: An increase in the incidence of atrial fibrillation (AF) during the acute phase of myocardial infarction (AMI) has been observed. But it is still unclear whether the implications of new-onset AF on in-hospital and long-term prognosis are of similar magnitude.

Methods: Using data from the CBD Bank study, 3,824 consecutive AMI patients, without prior AF, were analyzed. During the index hospitalization, all patients were monitored by continuous cardiac monitoring, twice daily performed 12- or 18-lead ECGs and timely ECG checks when cardiac symptoms occurred. Follow-up visits were routinely scheduled after discharge. Primary outcomes were all-cause death and cardiovascular death occurring during hospitalization and long-term follow-up. Secondary outcome was MACEs during hospitalization.

Results: During the median hospital stay of 9.0 (7.0, 11.0) days, new-onset AF was documented in 133 (3.48%) patients; 95 (71.43%) patients had AF attacks within 3 days following AMI. Independent risk factors associated with new-onset AF were older age, larger left atrial diameter, higher level of NT-proBNP, and primary PCI. New-onset AF was found to be significantly associated with in-hospital all-cause death (OR 4.33, 95%CI: 2.37-7.89, P < 0.001), cardiovascular death (OR 4.10, 95%CI: 2.18-7.73, P < 0.001), and MACEs (OR 2.51, 95%CI: 1.46-4.33, P = 0.001). A total of 112 new-onset AF and 3,338 non-AF patients were followed up for 1,090 (365, 1,694) days after discharge. There was no significant association between new-onset AF and long-term all-cause death (HR 1.21, 95%CI: 0.77-1.92, P = 0.406) or cardiovascular death (HR 1.09, 95%CI: 0.61-1.97, P = 0.764).

Conclusion: New-onset AF following AMI is strongly associated with an increased risk of adverse in-hospital prognosis, but it does not affect prognosis in those who survive until hospital discharge.

Keywords: acute myocardial infarction; in-hospital prognosis; long-term prognosis; new-onset atrial fibrillation; real world study.