Atrial fibrillation during acute myocardial infarction: association with all-cause mortality and sudden death after 7-year of follow-up
| Autor: | F. Cucchini, M. Pellegrinet, Fiorella Cavuto, Rocco Cordiano, Paolo Palatini, Giuseppe Berton |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Myocardial Infarction Angiotensin-Converting Enzyme Inhibitors Sudden death Death Sudden Intensive care Internal medicine Atrial Fibrillation medicine Humans Myocardial infarction Survival analysis Aged business.industry Digitalis Glycosides Atrial fibrillation General Medicine Odds ratio Length of Stay Middle Aged medicine.disease Surgery Italy Heart failure Cardiology Myocardial infarction complications Female business Epidemiologic Methods Anti-Arrhythmia Agents |
| Zdroj: | International journal of clinical practice. 63(5) |
| ISSN: | 1742-1241 |
| Popis: | SUMMARY Aims: Atrial fibrillation ⁄flutter (AF ⁄FL) is a common complication of acute myocardial infarction (AMI). Indeed, the determinants of AF ⁄FL in AMI-patients and the association of AF ⁄FL with mortality are not well-known. The purpose of the present study was to investigate the relationship between presence of AF ⁄FL and mortality in patients with AMI and to report on predictors of AF ⁄FL. Methods: We studied 505 patients enrolled in three intensive care units with definite AMI and followed up for 7 years. No patient was lost to follow-up. Patients with AF ⁄FL during the 1st week of hospitalisation were compared with those with steady sinus rhythm. End-points were all-cause mortality and modes of death. Results: At multivariable logistic regression analysis, elderly, body mass index, congestive heart failure (CHF), history of hypertension and plasma cholesterol (in a negative fashion) were independently associated with the presence of AF ⁄FL. At survival analysis, after full adjustment, AF ⁄FL was not associated with in-hospital mortality. After 7 years of follow-up, AF ⁄FL was found to be associated with all-cause mortality [adjusted odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.2‐2.3], together with age, diabetes mellitus, creatine kinase-MB isoenzyme (CK-MB) peak, CHF, estimated glomerular filtration rate and thrombolysis. At adjusted logistic polynomial regression analysis, AF ⁄FL was found to be associated with an excess of mortality for reasons of sudden death (SD) (adjusted OR = 2.7; 95% CI = 1.2‐6.4). No interaction was observed between AF ⁄FL and medications on in-hospital mortality. For 7-year mortality, angiotensin-converting enzyme (ACE)-inhibitors and digitalis showed an independent negative (protective) interaction chiefly on SD (adjusted OR = 0.06; 95% CI = 0.01‐0.74, and RR = 0.10; 95% CI = 0.02‐ 0.58, respectively). Conclusions: Patients with AMI and AF ⁄FL portend a poor prognosis in the long-term chiefly because of an excess of SD. Treatment with ACE-inhibitors and digitalis may have long-term beneficial effects on SD. What’s known • AF ⁄ FL during AMI is known to affect prognosis negatively, but few data are available for longterm mortality and causes of death. ACE-inhibitor and digitalis treatments affect outcomes after AMI, but differences in their effects on AMI patients with or without SR are not available in the long-term. What’s new |
| Databáze: | OpenAIRE |
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