From the Neufeld Cardiac Research Institute, Tel-Aviv University, Sheba
Medical Center, Tel Hashomer, Israel.
Correspondence to Michael Eldar, MD, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail meldar{at}post.tau.ac.il
Background—Paroxysmal atrial
fibrillation (PAF) is considered a frequent complication of acute
myocardial infarction (AMI), associated with increased in-hospital and
long-term mortality rates. This notion is based on data collected
before thrombolysis and additional modern methods of
treatment became widely available, and no information is available on
the significance of PAF in the general population with AMI in the
thrombolytic era. The aim of the present study was
to define the incidence, associated clinical parameters,
and short- and long-term prognostic significance of PAF in patients
with AMI in the thrombolytic era.
Methods and Results—A prospective, nationwide survey was
conducted of 2866 consecutive patients admitted with AMI in all 25
coronary care units in Israel during January/February 1992,
1994, and 1996 (thrombolytic era [TE]). The data were
compared with a previous Israeli study of 5803 patients with AMI
hospitalized in 1981 through 1983 (prethrombolytic era
[PTE]). Patients in the TE with PAF were older and had a worse risk
profile than those without PAF. PAF in the TE was independently
associated with increased 30-day (odds ratio, 1.32; 95% confidence
interval, 0.92 to 1.87) and 1-year (relative risk, 1.33; 95%
confidence interval, 1.05 to 1.68) mortality rates. The incidence of
PAF (8.9% and 9.9%) and the 30-day (25.1% and 27.6%) and 1-year
(38.4% and 42.5%) mortality rates of patients with PAF were similar
in the TE and PTE, although PAF in the TE occurred in older and sicker
patients than those in the PTE. After adjustment for conventional risk
factors, PAF was associated with significantly lower 30-day (odds
ratio, 0.64; 95% confidence interval, 0.44 to 0.94) and 1-year
(relative risk, 0.69; 95% confidence interval, 0.54 to 0.88) mortality
rates compared with the PTE.
Conclusions—Patients with AMI who develop PAF in the TE have
significantly worse short- and long-term prognoses than patients
without PAF, mostly due to their worse risk profile. After adjustment
for confounding factors, patients with PAF in the TE have a better
overall outcome than counterparts in the PTE, probably reflecting the
better management of patients with AMI in the TE.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Significance of Paroxysmal Atrial Fibrillation Complicating Acute Myocardial Infarction in the Thrombolytic Era
Key Words: myocardial infarction • thrombolysis • fibrillation
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