Document Detail


Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial.
MedLine Citation:
PMID:  20406769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The management of patients with atrial fibrillation (AF) following a myocardial infarction (MI) remains uncertain. This study compared a rate control strategy to an anti-arrhythmic-based rhythm control strategy for the treatment of AF following myocardial infarction. DESIGN, SETTING AND PATIENTS: We studied 1131 patients with AF after MI who were enrolled in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). We classified patients into those treated with a rhythm control strategy (n=371) and those treated with a rate control strategy (n=760). MAIN OUTCOMES MEASURES: Using Cox models, we compared the two groups with respect to both death and stroke during two different time periods after randomisation for which data collection had been pre-specified: 0-45 days and 45-1096 days. RESULTS: After adjustment, a rhythm control strategy was found to be associated with increased early mortality (0-45 days: HR: 1.9, 95% CI 1.2 to 3.0, p=0.004) but not late mortality (45-1096 days: HR 1.1, 95% CI 0.9 to 1.4, p=0.45). No difference was observed in the incidence of stroke (0-45 days: HR 1.2, 95% CI 0.4 to 3.7, p=0.73; 45-1096 days: HR 0.6, 95% CI 0.3 to 1.3, p=0.21). CONCLUSIONS: In patients with AF after an MI, an anti-arrhythmic drug-based rhythm control strategy is associated with excess 45-day mortality compared with a rate control strategy, but is not associated with increased mortality outside of the immediate peri-infarct period. These results potentially identify a patient population in whom the use of anti-arrhythmic drug therapy may portend an increased risk of death.
Authors:
Kent R Nilsson; Sana M Al-Khatib; Yi Zhou; Karen Pieper; Harvey D White; Aldo P Maggioni; Lars Kober; Christopher B Granger; Eldrin F Lewis; John J V McMurray; Robert M Califf; Eric J Velazquez
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-04-20
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  96     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-18     Completed Date:  2010-09-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  838-42     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. kent.nilsson@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Arrhythmia Agents / administration & dosage*
Atrial Fibrillation / complications,  drug therapy*,  mortality
Epidemiologic Methods
Female
Heart Failure / complications,  mortality
Humans
Male
Myocardial Infarction / complications,  mortality*
Stroke / etiology,  mortality
Ventricular Dysfunction, Left / complications,  mortality
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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