Elsevier

American Heart Journal

Volume 140, Issue 6, December 2000, Pages 878-885
American Heart Journal

Electrophysiology
New atrial fibrillation after acute myocardial infarction independently predicts death: The GUSTO-III experience,☆☆

https://doi.org/10.1067/mhj.2000.111108Get rights and content

Abstract

Background Atrial fibrillation (AF) or flutter occurring after myocardial infarction may occur alone or in association with other complications. Whether the arrhythmia portends a poor prognosis independent of other complications with contemporary therapy is unknown. Methods and Results As part of the Global Use of Strategies To Open occluded coronary arteries (GUSTO-III) trial, we evaluated whether postinfarction complications were associated with the subsequent development of AF and whether AF independently predicted death over periods of 30 days and 1 year. Information including exact timing was collected on deaths and major in-hospital postinfarction complications up to 30 days. Of the 13,858 patients with sinus rhythm at enrollment, 906 later had AF or flutter and 12,952 did not. We compared outcomes between these 2 groups, adjusting for differences in baseline characteristics and prefibrillation complications. Worsening heart failure, hypotension, third-degree heart block, and ventricular fibrillation were independent predictors of new-onset AF. The unadjusted odds ratio (OR) for death among patients with versus those without AF was 2.74 (95% confidence interval [95% CI], 2.56-3.34). After adjusting for baseline differences, the OR was reduced to 1.63 (95% CI, 1.31-2.02). Adjustment for other in-hospital complications before the onset of AF further reduced the OR to 1.49 (95% CI, 1.17-1.89). Conclusions Atrial fibrillation or flutter occurs secondary to other postinfarction complications but independently portends a worse prognosis. Prevention and management may improve outcome. (Am Heart J 2000;140:878-85.)

Section snippets

Methods

Enrollment criteria for GUSTO-III3 included patients of any age who were assessed after 30 minutes of continuous ischemic symptoms but within 6 hours of onset, together with ST-segment elevation or new left bundle-branch block. Exclusion criteria included active bleeding, prior stroke or central nervous system damage, recent major surgery, and severe hypertension. Patients were randomly assigned to receive either reteplase or alteplase, both with aspirin and heparin. The primary end point was

Results

Of the 15,059 patients in the GUSTO-III trial, 13,858 had sinus rhythm and 113 had AF at enrollment, 634 were recorded as having other rhythms, and 454 had missing data. Of the 13,858 patients with sinus rhythm, 906 had AF or atrial flutter during hospitalization (AF group) and 12,952 did not (the no-AF group). The median time from enrollment to onset of AF was 2.0 days (IQR, 0.75-4.5).

Patients in the new-onset AF group were older and more likely to be female; had higher rates of hypertension,

Discussion

This study reports the prognostic implications of new-onset AF or atrial flutter adjusted for the major in-hospital complications in patients who received contemporary treatment for acute MI. The important findings were that patients who had AF during hospitalization had more in-hospital complications even before the onset of AF, and AF predicted worse 30-day and 1-year mortality rates independent of both baseline characteristics and pre-AF complications.

Most previous studies of AF in acute MI

References (13)

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Cited by (0)

Supported by Centocor, Inc (Malvern, Pa), and Boehringer-Mannheim (Indianapolis, Ind, and Mannheim, Germany).

☆☆

Reprint requests: Prof Harvey D. White, DSc, Department of Cardiology, Green Lane Hospital, Epsom, Auckland 3, New Zealand. E-mail: [email protected]

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