© 2005 European Society of Cardiology
Previously known and newly diagnosed atrial fibrillation: A major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction
a Department of Cardiology, Non-Invasive Lab, Rigshospitalet 9 Blegdamsvej, Copenhagen, Denmark, 2100 Ø
b Sahlgrenska University Hospital/Østra Göteborg, Sweden
c University of Glasgow Glasgow, United Kingdom
d Brigham and Women's Hospital Boston, MA, United States
e Duke Clinical Research Institute, Duke University Medical Center Durham, NC, United States
f Estudios Cardiologicos Lationamerica Santa Fe, Argentina
g ANMCO Research Center Florence, Italy
h Myasnikov Card. Research Institute Moscow, Russia
i Centralny Szpital Kliniczny Akademii Medycznej Warsaw, Poland
j Gasthuisberg University Hospital Leuven, Belgium
k CIC INSERM-CHU Nancy France
l Julius-Maximilians-Universität Medizinische Würzburg, Germany
m Novartis Pharmaceuticals Corporation East Hanover, NJ, United States
n Toronto Hospital Toronto, Ontario, Canada
* Corresponding author. Tel.: +45 35 45 21 48; fax: +45 39 76 01 07. E-mail address: LK{at}HEART.DK (L. Køber).
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Abstract |
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Aims: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD).
Methods: The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and/or LVSD. AF was assessed at presentation and at randomization (median 4.9 days after symptom onset). Primary outcomes were risk of death and major CV events 3 years following acute MI.
Results: A total of 1812 with current AF (AF between presentation and randomization), 339 patients with prior AF (history of AF without current AF), and 12,509 without AF were enrolled. Patients with AF were older; had more prior HF, angina, and MI, and received beta-blockers and thrombolytics less often than those without AF. Three-year mortality estimates were 20% in those without AF, 37% with current AF, and 38% with prior AF. Compared with patients without AF, the multivariable adjusted HR of death was 1.25 (1.03–1.52; p = 0.03) for prior AF and 1.32 (1.20–1.45; p < 0.0001) for current AF. HR for major CV events was 1.15 (0.98–1.35; p = 0.08) and 1.21 (1.12–1.31; p < 0.0001).
Conclusion: AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD.
Key Words: Atrial fibrillation • Prognosis • Acute myocardial infarction
Received February 28, 2005; Revised August 28, 2005; Accepted November 17, 2005
The VALIANT trial was funded by a grant from Novartis Pharmaceutical Corporation, East Hanover, NJ, of which Dr. Zelenkofske is an employee.
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