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Outcomes in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

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Abstract

Background

In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with similar outcomes is a matter of debate.

Methods

We collected information for all patients with AMI seen in French hospitals between 2010 and 2019. Among 797,212 patients seen with STEMI or NSTEMI, 75,701 (9.5%) had history of AF, and 34,768 (4.4%) had new AF diagnosed between day 1 and day 30 after AMI.

Results

Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. During follow-up [mean (SD) 1.8 (2.4) years, median (interquartile range) 0.7 (0.1–3.1) years], 163,845 deaths and 30,672 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.17, 95% CI 1.16–1.19) and this was also the case for patients with new AF (adjusted HR 2.11, 2.07–2.15). Both history of AF and new AF were associated with a higher risk of ischemic stroke compared to patients with no AF: adjusted HR 1.19 (1.15–1.23) for history of AF, adjusted HR 1.78 (1.68–1.88) for new AF. New AF was associated with a higher risk of death and of ischemic stroke than history of AF: adjusted HR 1.74 (1.70–1.79) and 1.32 (1.23–1.42), respectively.

Conclusions

In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was independently associated with higher risks of death and ischemic stroke than those in patients with no AF or previously known AF.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Laurent Fauchier.

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Conflict of interest

LF: consultant or speaker activities for Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic, and Novartis. BP: personal fees from Abbott, Biotronik, Boston Scientific and Microport. NC: consultant activities for Medtronic and Boston Scientific. ND: personal fees and nonfinancial support from Amgen, AstraZeneca, BMS, Bayer, Pfizer, Boehringer Ingelheim, Intercept, MSD, Novo Nordisk, Sanofi, Servier, and UCB, outside the submitted work. YC: Consultant or speaker for Bayer, BMS/Pfizer, Boehringer Ingelheim, Novartis, Sanofi and Servier. All other authors declare no competing interests.

Ethics approval

The study was conducted retrospectively and, as patients were not involved in its conduct, there was no impact on their care. Ethical approval was not required, as all data were anonymized. The French Data Protection Authority granted access to the PMSI data. Procedures for data collection and management were approved by the Commission Nationale de l'Informatique et des Libertés, the independent National Ethical Committee protecting human rights in France, which ensures that all information is kept confidential and anonymous, in compliance with the Declaration of Helsinki (authorization number 1897139).

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The data and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure. Because this study used data from human subjects, the data and everything pertaining to the data are governed by the French Health Agencies and cannot be made available to other researchers.

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Fauchier, L., Bisson, A., Bodin, A. et al. Outcomes in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis. Clin Res Cardiol 110, 1431–1438 (2021). https://doi.org/10.1007/s00392-021-01805-2

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  • DOI: https://doi.org/10.1007/s00392-021-01805-2

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