RT Journal Article
SR Electronic
T1 Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 838
OP 842
DO 10.1136/hrt.2009.180182
VO 96
IS 11
A1 Kent R Nilsson, Jr
A1 Sana M Al-Khatib
A1 Yi Zhou
A1 Karen Pieper
A1 Harvey D White
A1 Aldo P Maggioni
A1 Lars Kober
A1 Christopher B Granger
A1 Eldrin F Lewis
A1 John J V McMurray
A1 Robert M Califf
A1 Eric J Velazquez
YR 2010
UL http://heart.bmj.com/content/96/11/838.abstract
AB 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.