Atrial fibrillation types predict the development of contrast-induced nephropathy in patients with acute myocardial infarction treated invasively

Abstract

Purpose: The aim of the study was to assess the clinical impact of atrial fibrillation (AF) types on developing contrast induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention. Methods: We analyzed 2, 980 consecutive AMI-patients treated invasively, who were admitted to our center between 2003 and 2008. Data on in-hospital follow up were screened to identify subjects who developed CIN during index hospitalization. Additionally data on long-term follow up were collected to assess prognosis in this population. Results: CIN was recognized in 719 (24.13%) patients (CIN group), whereas in 2,261 (75.87%) patients (Control Group) no significant deterioration of renal function was detected. The incidence of atrial fibrillation was significantly higher in CIN group: 14.74% vs 7.8% (p<0.001). The incidence of pre-hospital non-permanent AF (AF Group 1), new-onset AF (AF Group 2) and permanent AF (AF Group 3) in CIN group was: 3.76%, 6.54% and 4.45% respectively. Apart from glomerular filtration rate < 60ml/min/m2 (HR 3.63) and left ventricular ejection fraction <35% (HR 2.63), new-onset AF (HR 2.50) as well as permanent AF (HR 2.03) were the most powerful independent predictors of CIN in the studied population. Long-term mortality was significantly higher in AF Group 2 and 3 than in AF Group 1 and CIN population free of this arrhythmia: 61.7% and 59.4% respectively vs 29.6% and 26.6% respectively (all p<0.001). ![Figure][1] Cumulative proportion of survival Conclusions: New-onset atrial fibrillation and permanent AF were strong independent risk factors for CIN in AMI-patients treated invasively. These two types of arrhythmia were also independently associated with significantly higher short- and long-term mortality in AMI-patients with concomitant CIN. [1]: pending:yes