Document Detail


The long-term risk of stroke in patients with acute myocardial infarction complicated with new-onset atrial fibrillation.
MedLine Citation:
PMID:  19685521     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The long-term risk of stroke after acute myocardial infarction (AMI) complicated with new-onset atrial fibrillation (AF) remains unclear. The aim of this study was to determine the long-term risk of AF and stroke in patients with AMI complicated with new-onset AF. METHODS: Patients with AMI complicated with new-onset AF (n = 260) and those without new-onset AF (n = 292) were followed for a mean of 7 years. All patients had sinus rhythm at hospital discharge. RESULTS: During the follow-up, AMI patients with new-onset AF had more frequent AF than those without new-onset AF (10.4% vs 2.7%, respectively; P < 0.0001). New-onset AF during AMI was a significant predictor of subsequent AF occurrence (the time elapsing between 2 consecutive R waves [RR] = 3.15, P = 0.004); but AF recurrence in follow-up (RR = 5.08, P = 0.001) and non-anticoagulation at discharge (RR = 0.29, P = 0.008) were independent predictors of stroke (Cox regression analysis). A period of 3.5 hours of AF within the first 48 hours of AMI was the high sensitivity cut-off level for the prediction of low long-term risk of stroke obtained by receiver operating characteristic analysis. Among patients who did not receive anticoagulants at discharge, the patients with short AF did not experience stroke and AF recurrence during follow-up, while those in the other group developed it (10.8%, P = 0.038 and 13.5%, P = 0.019, respectively). CONCLUSION: New-onset AF during AMI identifies the patients at long-term risk for stroke who may potentially benefit from anticoagulant therapy. Atrial fibrillation recurrence in follow-up was independently related to the development of stroke. However, for low-risk patients with AF (those with short AF occurring early in AMI) long-term anticoagulants might not be required.
Authors:
Milika R Asanin; Asanin R Milika; Zorana M Vasiljevic; Vasiljevic M Zorana; Mihailo D Matic; Matic D Mihailo; Igor B Mrdovic; Mrdovic B Igor; Jovan P Perunicic; Perunicic P Jovan; Danica P Matic; Matic P Danica; Bosiljka D Vujisic-Tesic; Vujisic-Tesic D Bosiljka; Sanja D Stankovic; Stankovic Dj Sanja; Dragan M Matic; Matic M Dragan; Miodrag C Ostojic; Ostojic C Miodrag
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  32     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-24     Completed Date:  2009-10-29     Revised Date:  2010-06-24    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  467-70     Citation Subset:  IM    
Affiliation:
Emergency Center, Clinical Center of Serbia, University Institute of Cardiovascular Diseases, Belgrade, Serbia. masanin@Eunet.rs
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Aged
Anticoagulants / administration & dosage*
Atrial Fibrillation / drug therapy,  etiology*
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Myocardial Infarction / complications*,  drug therapy
Patient Selection
Predictive Value of Tests
Proportional Hazards Models
ROC Curve
Recurrence
Risk Assessment
Risk Factors
Stroke / etiology*,  prevention & control
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections
Erratum In:
Clin Cardiol. 2010 Jun;33(6):379
Note: Milika, Asanin R [corrected to Asanin, Milika R]; Zorana, Vasiljevic M [corrected to Vasiljevic, Zorana M]; Mihailo, Matic D [corrected to Matic, Mihailo D]; Igor, Mrdovic B [corrected to Mrdovic, Igor B]; Jovan, Perunicic P [corrected to Perunicic, Jovan P]; Danica, Matic P [corrected to Matic, Danica P]; Bosiljka, Vujisic-Tesic D [corrected to Vujisic-Tesic, Bosiljka D]; Sanja, Stankovic Dj [corrected to Stankovic, Sanja D]; Dragan, Matic M [corrected to Matic, Dragan M]; Miodrag, Ostojic C [corrected to Ostojic, Miodrag C]

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