Article Text

Download PDFPDF

Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data
  1. F Pizzettib,
  2. F M Turazzaa,
  3. M G Franzosia,
  4. S Barleraa,
  5. A Leddac,
  6. A P Maggionid,
  7. L Santoroa,
  8. G Tognoni on behalf of the GISSI-3 Investigatorsa
  1. aDepartment of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy, bDivision of Cardiology, S Spirito Hospital, Casale Monferrato (AL), Italy, cDivision of Cardiology, Cervello Hospital, Palermo, Italy, dCentro Studi, ANMCO, Florence, Italy
  1. Dr F M Turazza, GISSI Coordinating Centre, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62, 20157 Milan, Italydepcardio{at}irfmn.mnegri.it

Abstract

BACKGROUND Atrial 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.

OBJECTIVE To 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.

METHODS Data 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.

RESULTS The 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).

CONCLUSIONS Atrial 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.

  • atrial fibrillation
  • acute myocardial infarction
  • prognosis
View Full Text

Statistics from Altmetric.com

Footnotes

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.