Title: Cardiac and Extra Cardiac Predictors and Complications of Acute Atrial Fibrillation Complicating ST Elevation Myocardial Infarction (STEMI)
ST Elevation myocardial infarction Acute Atrial Fibrillation (STAAF) Study
Authors: Dr Supriya D Nambiar, Dr Mathew Iype, Prof. Sunitha Viswanathan, Prof. George Koshy, Prof. Prabha Nini Gupta, Prof. V.V. Radhakrishnan
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.139
Abstract
Study Population and Design: Acute Atrial Fibrillation (AF) is an important complication of ST Segment Elevation Myocardial Infarction (STEMI) even in the Primary angioplasty era. AF is an independent predictor of both short termand long term mortality. What is the incremental risk of developing complications when AF complicates STEMI?
Materials and Methods: It was a single center, prospective cohort study, conducted from October 2014 to January 2016. The patients were divided into three groups. 1. Those with AF at admission. 2. Those developing AF within 24 hours of admission. 3. Those developing AF after 24 hours and till discharge. The patient’s clinical and echocardiographic profile were documented. They were followed up for development of heart failure, arrhythmias, cardiogenic shock, Cerebrovascular Accident (CVA) and death.
Results: A total of 118 STEMI patients (59 with AF and 59 without) were included in the study. In-hospital (20.3% vs. 6.8% p= 0.031) and total mortality was significantly higher in AF Group (23.7% vs. 10.2%, p=0.040). 1 and 3 month mortality were not significantly different in AF and non AF groups. The in-hospital MACCE rate was higher in the AF group. The 1 and 3 month MACCE were not significantly different. Pericarditis was more common in patients who had AF.(20.3% vs. 6.8%,p= 0.03). Acute Kidney Injury was more in AF group.(16.9 % vs. 5.1%, p=0.04). Age>/=70, systemic hypertension, Left Ventricular EF<40%, Left Atrial dilatation, ischemic mitral regurgitation >/=grade2 were significant predictors of AF on univariate analysis. Hypertension was the only independent predictor of AF in multivariate analysis.
Keywords: Atrial Fibrillation, ST Elevation Myocardial Infarction, Myocardial infarction complications.
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