Association between CHADS2 Score and the Preventive Effect of Statin Therapy on New-Onset Atrial Fibrillation in Patients with Acute Myocardial Infarction

Jaw-Wen Chen,Adrian V Hernandez,Hsin-Bang Leu,Shao-Sung Huang,Shing-Jong Lin,Po-Hsun Huang,Wan-Leong Chan

doi:10.1371/journal.pone.0074709

Abstract

ObjectivesNew-onset atrial fibrillation (AF) commonly occurs in patients with acute myocardial infarction (AMI). Data regarding the value of the CHADS2 score in patients hospitalized for AMI is limited. This study aimed to determine whether the CHADS2 score is associated with new-onset AF and if it can help identify the patients who will benefit most from statin use for the prevention of arrhythmia after AMI.MethodsA total of 724 consecutive AMI patients were enrolled in this study. The patients were divided into 3 groups according to their CHADS2 scores: group 1, score 0; group 2, score 1–2; and group 3, score 3–6. The study endpoint was an episode of new-onset AF that lasted more than 30 seconds during hospitalization at the coronary care unit.ResultsSeventy-eight (10.8%) patients developed new-onset AF, and 273 (37.7%) were on a statin upon admission. The incidence of new-onset AF increased significantly from 5.8% in group 1 to 11.3% in group 2 and 14.3% in group 3 (χ2 for linear trend, P = 0.017). Statin use (odds ratio [OR], 0.22; 95% CI, 0.06–0.85) and CHADS2 score (OR, 1.53; 95% CI, 1.02–2.28) were independent predictors of new-onset AF in AMI patients. Patients with CHADS2 score ≤2 had significantly reduced C-reactive protein level and lower risk of developing new-onset AF if they were taking statins (P < 0.05). Multivariate logistic regression analysis demonstrated the benefit of statin use for preventing new-onset AF in patients with CHADS2 scores ≤2 (OR, 0.34; 95% CI, 0.14–0.81).ConclusionsThe CHADS2 score is a convenient scoring system for predicting the incidence of new-onset AF and may help in identifying the patients who will benefit most from statin use for the prevention of arrhythmia after AMI.

Highlights

Preexisting or new-onset atrial fibrillation (AF) commonly occurs in patients with acute coronary syndrome (ACS) [1,2] and is associated with complications
The present results indicate that in a cohort of acute myocardial infarction (AMI) patients, the incidence of new-onset AF was increased in patients with higher CHADS2 scores
These findings suggest that the CHADS2 score may help identify the AMI patients who will benefit most from statin use for the prevention of new-onset AF

Summary

Introduction

Preexisting or new-onset atrial fibrillation (AF) commonly occurs in patients with acute coronary syndrome (ACS) [1,2] and is associated with complications. Using data from patients with ACS, who were enrolled in the Global Registry of Acute Coronary Events, Mehta et al found that preexisting and newonset AF are associated with increased hospital morbidity and mortality as compared to ACS patients without any AF. Only new-onset AF is an independent predictor of inhospital adverse events in patients with ACS [3]. AF is associated with a greater 30-day mortality (29.3% vs 19.1%) and 1-year mortality (48.3% vs 32.7%) in patients with acute myocardial infarction (AMI) [2]. AF is more commonly associated with AMI in older patients and in those with higher Killip class or left ventricular dysfunction [4]. Many studies on pharmacological therapies have shifted to non-channel blocking drugs with pleiotropic properties that have the potential to alter the underlying atrial substrate without concomitant pro-arrhythmic effects [6,7]

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