Impact of Glomerular Filtration Rate on the Incidence and Prognosis of New-Onset Atrial Fibrillation in Acute Myocardial Infarction.

Nicola Cosentino,Fabrizio Veglia,Jeness Campodonico,Alice Bonomi,Valentina Milazzo,Monica De Metrio,Emilio Assanelli,Ivana Marana,Mara Rubino,Giancarlo Marenzi,Marco Grazi,Marco Moltrasio,Simonetta Genovesi,Antonio L Bartorelli,Gianfranco Lauri,Marco Ballarotto

doi:10.3390/jcm9051396

Abstract

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated. Methods: We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 (n = 1887): GFR >60; group 2 (n = 492): GFR 60–30; group 3 (n = 66): GFR <30 mL/min/1.73 m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints. Results: The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively (p < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; p < 0.0001) and long-term (34% vs. 13%; p < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; p < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; p < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission.

Highlights

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it often complicates acute myocardial infarction (AMI) [1,2,3,4,5,6,7,8]
Despite the evidence accumulated in the general population, no specific data are available regarding the relationship between AF and glomerular filtration rate (GFR) in AMI
In this clinical setting, serum creatinine (sCr) value measured at hospital admission, from which GFR is usually estimated, may reflect a variable combination of pre-existing chronic kidney disease (CKD) and ongoing acute kidney injury due to hemodynamic instability associated with AMI

Summary

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it often complicates acute myocardial infarction (AMI) [1,2,3,4,5,6,7,8]. A systematic review of the published literature demonstrated that new-onset AF in AMI has serious adverse implications regarding both in-hospital and long-term mortality [8]. Very little is known about the incidence of new-onset AF, its correlates, and its association with short-term and long-term prognosis in AMI patients across glomerular filtration rate (GFR) values. AF was associated with a higher in-hospital (5% vs 1%; p < 0.0001) and long-term (34% vs 13%; p < 0.0001) mortality. The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission

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