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(Circulation. 2005;112:3212-3214.)
© 2005 American Heart Association, Inc.

Editorial

Oral Anticoagulation for Atrial Fibrillation After ST-Elevation Myocardial Infarction

New Evidence to Guide Clinical Practice

Frederick G. Kushner, MD; Elliott M. Antman, MD

From the Tulane School of Medicine, New Orleans, La (F.G.K.), and Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Mass (E.M.A.).

Correspondence to Elliott M. Antman, MD, Professor of Medicine, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis St, Boston, MA 02115. E-mail eantman@rics.bwh.harvard.edu

Key Words: Editorials • myocardial infarction • anticoagulants • fibrillation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Atrial fibrillation (AF) in the setting of ST-segment elevation myocardial infarction (STEMI) is estimated to occur in up to 20% of patients, depending on the population studied.^1–3 The development of AF during hospitalization for STEMI is associated with a significant increase in both in-hospital and short-term mortality (odds ratio, 1.4 to 1.98).³ Predictors of developing AF include increased age, magnitude of creatine kinase elevation, Killip class, anterior location of infarction, left ventricular dysfunction, and both hypertension and hypotension. Those patients who develop AF during their hospitalization have a worse prognosis than those who present with AF on admission.¹ Even in the fibrinolytic era, stroke rates are increased in STEMI patients with AF.⁴

Article p 3225

Clinical trials have addressed the efficacy of oral anticoagulation (OAC) in patients with AF but without STEMI,⁵ and other studies have addressed the efficacy of OAC in post-STEMI patients. There are, however, no randomized controlled trials of OAC with or without antiplatelet therapy specifically in the cohort that includes patients with both STEMI and AF. In the Warfarin, Aspirin, Reinfarction Study (WARIS II) of 3630 MI patients, high-intensity warfarin (international normalized ratio [INR], 2.8 to 4.2) was compared with medium-intensity warfarin (INR, 2 to 2.5) plus aspirin (ASA) 75 mg and with ASA 160 mg alone in patients <75 years of age.⁶ There was a 29% reduction in the rate of the composite end point of death, nonfatal reinfarction, or thromboembolic stroke in the combined group and a 19% reduction in the high-intensity group versus . . . [Full Text of this Article]

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