ElectrophysiologyNew atrial fibrillation after acute myocardial infarction independently predicts death: The GUSTO-III experience☆,☆☆
Section snippets
Methods
Enrollment criteria for GUSTO-III3 included patients of any age who were assessed after 30 minutes of continuous ischemic symptoms but within 6 hours of onset, together with ST-segment elevation or new left bundle-branch block. Exclusion criteria included active bleeding, prior stroke or central nervous system damage, recent major surgery, and severe hypertension. Patients were randomly assigned to receive either reteplase or alteplase, both with aspirin and heparin. The primary end point was
Results
Of the 15,059 patients in the GUSTO-III trial, 13,858 had sinus rhythm and 113 had AF at enrollment, 634 were recorded as having other rhythms, and 454 had missing data. Of the 13,858 patients with sinus rhythm, 906 had AF or atrial flutter during hospitalization (AF group) and 12,952 did not (the no-AF group). The median time from enrollment to onset of AF was 2.0 days (IQR, 0.75-4.5).
Patients in the new-onset AF group were older and more likely to be female; had higher rates of hypertension,
Discussion
This study reports the prognostic implications of new-onset AF or atrial flutter adjusted for the major in-hospital complications in patients who received contemporary treatment for acute MI. The important findings were that patients who had AF during hospitalization had more in-hospital complications even before the onset of AF, and AF predicted worse 30-day and 1-year mortality rates independent of both baseline characteristics and pre-AF complications.
Most previous studies of AF in acute MI
References (13)
- et al.
Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience
J Am Coll Cardiol
(1997) - et al.
Survival after recovery from acute myocardial infarction: two and five year prognostic indices
Am J Med
(1979) - et al.
Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective
Am Heart J
(1990) - et al.
Disturbance of rate, rhythm and conduction in acute myocardial infarction
Am J Med
(1964) - et al.
Atrial fibrillation developing in the acute phase of myocardial infarction
Chest
(1976) - et al.
Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era
Circulation
(1998)
Cited by (0)
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Supported by Centocor, Inc (Malvern, Pa), and Boehringer-Mannheim (Indianapolis, Ind, and Mannheim, Germany).
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Reprint requests: Prof Harvey D. White, DSc, Department of Cardiology, Green Lane Hospital, Epsom, Auckland 3, New Zealand. E-mail: [email protected]