Incidence and predictors of new-onset atrial fibrillation in ST-elevation myocardial infarction: A single-center study

Behrouz Zarei; Ali Bozorgi; Mehran Khoshfetrat; Reza Arefizadeh; Seyed Abolfazl Mohsenizadeh; Seyyed Hossein Mousavi; Arash Jalali; Akbar Shafiee

doi:10.1002/hsr2.2226

Incidence and predictors of new-onset atrial fibrillation in ST-elevation myocardial infarction: A single-center study

Health Sci Rep. 2024 Jul 1;7(7):e2226. doi: 10.1002/hsr2.2226. eCollection 2024 Jul.

Authors

Behrouz Zarei¹, Ali Bozorgi², Mehran Khoshfetrat¹, Reza Arefizadeh¹, Seyed Abolfazl Mohsenizadeh¹, Seyyed Hossein Mousavi¹, Arash Jalali³, Akbar Shafiee³

Affiliations

¹ Department of Cardiology, School of Medicine AJA University of Medical Sciences Tehran Iran.
² Department of Cardiology, Tehran Heart Center, Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran.
³ Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran.

Abstract

Background and aims: Atrial fibrillation (AF) is a common arrhythmia that occurs following ST-elevation myocardial infarction (STEMI) and can significantly impact clinical outcomes. We investigated the incidence and predictors of AF following STEMI in patients, as well as its association with major adverse cardiac and cerebrovascular events (MACCE).

Methods: We conducted a retrospective cohort study, including all STEMI patients who presented under code 247 to Tehran Heart Center between 2016 and 2020 and completed a 1-year follow-up. Patients were divided into two groups based on the development of AF during follow-up, and their baseline and clinical characteristics were compared. We used multivariable regression models to identify predictors of MACCE.

Results: Out of 3647 STEMI patients, 84 (2.3%) developed new-onset AF (NOAF). Patients with AF were significantly older and had lower levels of total and low-density lipoprotein cholesterol, triglyceride, and hemoglobin, but higher levels of fasting blood sugar and creatinine. AF patients were also more likely to have a history of hypertension, chronic kidney disease (CKD), congestive heart failure, and cerebrovascular accidents. The multivariable logistic regression model identified the CHA₂DS₂-VASc score and CKD as independent predictors of NOAF following primary percutaneous coronary intervention. Furthermore, the incidence of MACCE was higher in the AF group, and AF independently predicted MACCE with a hazard ratio of 2.766.

Conclusion: The CHA₂DS₂-VASc score and the presence of CKD can serve as useful predictors of NOAF among patients with STEMI. Early detection and appropriate management are crucial to improve outcomes.

Keywords: ST‐elevation myocardial infarction; atrial fibrillation; clinical outcome; primary percutaneous coronary intervention.