Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction

• Published in: Journal of clinical medicine 2024-04, Vol.13 (8), p.2318
• Main Authors: Shakeel, Iqra, Sharma, Harish, Hodson, James, Iqbal, Hamna, Tashfeen, Rashna, Ludman, Peter F, Steeds, Richard P, Townend, Jonathan N, Doshi, Sagar N, Nadir, M Adnan
• Format: Article
• Language: English
• Subjects: Angioplasty; Anticoagulants; Atrial fibrillation; Cardiac arrhythmia; Cardiac patients; Cardiovascular disease; Care and treatment; Clopidogrel; Comorbidity; Complications and side effects; Coronary heart disease; Coronary vessels; Development and progression; Electronic health records; Heart attack; Heart attacks; Missing data; Patients; Risk factors; Statistics; Ticagrelor; Transluminal angioplasty; Variables
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13082318

Concomitant atrial fibrillation (AF) is associated with an adverse prognosis in patients with acute myocardial infarction (MI). However, it remains unclear whether this is due to a causal effect of AF or whether AF acts as a surrogate marker for comorbidities in this population. Furthermore, there are limited data on whether coronary artery disease distribution impacts the risk of developing AF. Consecutive patients admitted with acute MI and treated using percutaneous coronary intervention (PCI) at a single centre were retrospectively identified. Associations between AF and major adverse cardiac and cerebrovascular events (MACCEs) over a median of five years of follow-up were assessed using Cox regression, with adjustment for confounding factors performed using both multivariable modelling and a propensity-score-matched analysis. AF was identified in N = 65/1000 (6.5%) of cases; these patients were significantly older (mean: 73 vs. 65 years, < 0.001), with lower creatinine clearance ( < 0.001), and were more likely to have a history of cerebrovascular disease ( = 0.011) than those without AF. In addition, patients with AF had a greater propensity for left main stem ( = 0.001) or left circumflex artery ( = 0.004) involvement. Long-term MACCE rates were significantly higher in the AF group than in the non-AF group (50.8% vs. 34.2% at five years), yielding an unadjusted hazard ratio (HR) of 1.86 (95% CI: 1.32-2.64, < 0.001). However, after adjustment for confounding factors, AF was no longer independently associated with MACCEs, either on multivariable (adjusted HR: 1.25, 95% CI: 0.81-1.92, = 0.319) or propensity-score-matched (HR: 1.04, 95% CI: 0.59-1.82, = 0.886) analyses. AF is observed in 6.5% of patients admitted with acute MI, and those with AF are more likely to have significant diseases involving left main or circumflex arteries. Although unadjusted MACCE rates were significantly higher in patients with AF, this effect was not found to remain significant after adjustment for comorbidities. As such, this study provided no evidence to suggest that AF is independently associated with MACCEs.