Heart 2001;86:527-532 ( November )

Cardiovascular medicine

Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data F Pizzetti^b, F M Turazza^a, M G Franzosi^a, S Barlera^a, A Ledda^c, A P Maggioni^d, L Santoro^a, G Tognoni^a, on behalf of the GISSI-3 Investigators

^a Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy, ^b Division of Cardiology, S Spirito Hospital, Casale Monferrato (AL), Italy, ^c Division of Cardiology, Cervello Hospital, Palermo, Italy, ^d Centro Studi, ANMCO, Florence, Italy

Correspondence to: Dr F M Turazza, GISSI Coordinating Centre, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62, 20157 Milan, Italy depcardio{at}irfmn.mnegri.it

Accepted 11 July 2001

BACKGROUNDAtrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infarction. Recent advances in pharmacological treatment of myocardial infarction may have changed the impact of this arrhythmia.
OBJECTIVETo assess the incidence and prognosis of atrial fibrillation complicating myocardial infarction in a large population of patients receiving optimal treatment, including angiotensin converting enzyme (ACE) inhibitors.
METHODSData were derived from the GISSI-3 trial, which included 17 944 patients within the first 24 hours after acute myocardial infarction. Atrial fibrillation was recorded during the hospital stay, and follow up visits were planned at six weeks and six months. Survival of the patients at four years was assessed through census offices.
RESULTSThe incidence of in-hospital atrial fibrillation or flutter was 7.8%. Atrial fibrillation was associated with indicators of a worse prognosis (age > 70 years, female sex, higher Killip class, previous myocardial infarction, treated hypertension, high systolic blood pressure at entry, insulin dependent diabetes, signs or symptoms of heart failure) and with some adverse clinical events (reinfarction, sustained ventricular tachycardia, ventricular fibrillation). After adjustment for other prognostic factors, atrial fibrillation remained an independent predictor of increased in-hospital mortality: 12.6% v 5%, adjusted relative risk (RR) 1.98, 95% confidence interval (CI) 1.67 to 2.34. Data on long term mortality (four years after acute myocardial infarction) confirmed the persistent negative influence of atrial fibrillation (RR 1.78, 95% CI 1.60 to 1.99).
CONCLUSIONSAtrial fibrillation is an indicator of worse prognosis after acute myocardial infarction, both in the short term and in the long term, even in an unselected population.


Keywords: atrial fibrillation; acute myocardial infarction; prognosis

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© 2001 by Heart
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