Document Detail

Atrial fibrillation and death after myocardial infarction: a community study.
MedLine Citation:
PMID:  21536994     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atrial fibrillation (AF) often coexists with myocardial infarction (MI), yet its prognostic influence is disputed. Prior reports studied the relationship of AF during early hospitalization for acute MI to the risk of death and could not address the timing of AF in relation to the MI (ie, before, during, after). Furthermore, as data come mostly from clinical trials, their applicability to the community is uncertain. The aims of our study were to assess the occurrence of AF among MI patients, determine whether it has changed over time, and quantify its impact and the impact of its timing on mortality after MI.
METHODS AND RESULTS: This was a community-based cohort of 3220 patients hospitalized with incident (first-ever) MI from 1983 to 2007 in Olmsted County, MN. Atrial fibrillation was identified by diagnostic codes and ECG. Outcomes were all-cause and cardiovascular death. Atrial fibrillation before MI was identified in 304 patients, and 729 developed AF after MI (218 [30%] within 2 days, 119 [16%] between 3 and 30 days, and 392 [54%] >30 days post-MI). The cumulative incidence of AF after MI at 5 years was 19% and did not change over the calendar year of MI (the incidence of AF was the same regardless of when the MI occurred). During a mean follow-up of 6.6 years, 1638 deaths occurred. AF was associated with an increased risk of death (hazard ratio [95% confidence interval] 3.77 [3.37 to 4.21]), independently of clinical characteristics at the time of MI and heart failure. This risk differed markedly according to the timing of AF, and was the greatest for AF occurring >30 days post MI (hazard ratio [95% confidence interval] 1.63 [1.37 to 1.93] for AF within 2 days, 1.81 [0.45 to 2.27] for AF between 3 and 30 days, and 2.58 [2.21 to 3.00] for AF >30 days post MI).
CONCLUSIONS: In the community, AF is frequent in the setting of MI. Atrial fibrillation carries an excess risk of death, which is the highest for AF developing >30 days after MI.
Patricia Jabre; Xavier Jouven; Frédéric Adnet; Gabriel Thabut; Suzette J Bielinski; Susan A Weston; Véronique L Roger
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-05-02
Journal Detail:
Title:  Circulation     Volume:  123     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-17     Completed Date:  2011-07-19     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2094-100     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / epidemiology*,  physiopathology
Cohort Studies
Follow-Up Studies
Middle Aged
Myocardial Infarction / epidemiology*,  mortality*,  physiopathology
Retrospective Studies
Risk Factors
Time Factors
Grant Support
AG034676/AG/NIA NIH HHS; R01 AG034676/AG/NIA NIH HHS; R01 AG034676-46/AG/NIA NIH HHS; R01 HL 59205/HL/NHLBI NIH HHS; R01 HL059205/HL/NHLBI NIH HHS; R01 HL059205-13/HL/NHLBI NIH HHS
Comment In:
Expert Rev Cardiovasc Ther. 2011 Sep;9(9):1111-3   [PMID:  21932953 ]
Ann Intern Med. 2011 Sep 20;155(6):JC3-13   [PMID:  21930850 ]

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