Highlights
- •Atrial fibrillation (AF) is often complicated with acute myocardial infarction (AMI).
- •AF was an independent risk factor for major adverse cardiac events in AMI registry.
- •AF was not an independent risk factor for bleeding events in AMI registry.
Abstract
Background
The clinical incidence and impact of atrial fibrillation (AF) in Japanese acute myocardial
infarction (AMI) patients is not fully understood.
Methods
To elucidate the clinical incidence and impact of AF on in-hospital mortality in AMI
patients, we analyzed a Japanese observational prospective multicenter registry of
acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry), which
spans 2015 to 2019. A major adverse cardiac event (MACE) was defined as cardiovascular
death, non-fatal myocardial infarction (MI), and non-fatal stroke. For assessing bleeding
events, Bleeding Academic Research Consortium (BARC) type 3 or 5 was used. MACE plus
BARC type 3 or 5 bleeding were considered as composite events. The clinical outcomes
were followed for 1 year.
Results
The total of 5059 patients included 531 patients with AF (10.5%) and 4528 patients
with sinus rhythm (SR; 89.5%). AF patients were significantly older and tended to
have more comorbidities than SR patients. Oral anticoagulation therapy (OAC) was used
in 44% of AF patients while single antiplatelet therapy was selected for 52% of patients
with OAC. Crude in-hospital mortality was significantly greater in AF patients than
in SR patients (10.4%, 5.0%, respectively, p < 0.01). The multivariate analysis was adjusted for age, sex, diabetes, hypertension,
hemodialysis, smoking, previous MI, body mass index, Killip classification, out of
hospital cardiac arrest, and OAC. In-hospital mortality was still significantly greater
in AF patients than in SR patients in the logistic regression analysis [adjusted odds
ratio 2.02 (1.31–3.14)]. AF was an independent risk factor for MACE and composite
events in the Cox proportional hazards model [adjusted risk ratio (ARR) 1.91 (1.36–2.69),
p < 0.01; ARR 1.72 (1.25–2.36), p < 0.01]. In contrast, AF was not an independent risk factor for bleeding [ARR 1.71
(0.79–3.71), p = 0.18].
Conclusion
In Japanese AMI patients, AF was often observed and was associated with worse MACE
but not worse bleeding.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 23, 2022
Accepted:
February 4,
2022
Received in revised form:
January 21,
2022
Received:
October 17,
2021
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
