Prediktori i ishod novonastale atrijumske fibrilacije kod bolesnika sa akutnim infarktom miokarda
Sažetak
Uvod/Cilj. Pojava atrijalne fibrilacije (AF) u akutnoj fazi infarkta miokarda (MI) može biti prediktor loše prognoze. Cilj naše studije bio je da ispitamo ovu povezanost. Metode. Ukupno, 600 bolesnika je uključeno u istraživanje i podijeljeno u dve grupe. Prva grupa je obuhvatila bolesnike sa novonastalom AF, dok je druga grupa obuhvatila bolesnika bez ove aritmije. Bolesnici sa ranije registrovanom AF isključeni bili su iz istraživanja. Ispitivana je korelacija između novonastale AF i intrahospitalnog odnosno mortaliteta u toku perioda praćenja od 48 mjeseci. Takođe, analizirani su prediktori novonastale AF. Rezultati. Novonastala AF registrovana je kod 48 (8%) bolesnika. Nezavisni prediktor novonastale AF bilo je životno doba, naročito preko 70 godina [odds ratio 2,37; confidence interval (CI) 1,23–4,58), a potom i povišeni indeks telesne mase (odds ratio 1,17; 95% CI 1,04–1,33). Bolesnici sa novonastalom AF imali su povišeni intrahospitalni mortalitet u odnosu na one bez tog poremećaja srčanog ritma, ali ova razlika nije bila statistički značajna (10,4% vs 5,6%; p = 0,179. Bolesnici sa novonastalom AF imali su povišeni mortalitet nakon perioda praćenja od 48 meseci (33,3 % vs 17,8%; p = 0,009). Veliki neželjeni kardiovaskularni događaji (major adverse cardiac and cardiovascular events – MACCE) koji obuhvataju smrt, ponovni MI, odnosno revaskularizaciju i šlog, bili su češće prisutni kod bolesnika sa novonastalom AF (52,1% vs 33,9%; p = 0,011) tokom perioda praćenja od 48 meseci. Međutim, u multi-varijantnom Cox regresionom modelu novonastala AF nije identifikovana kao nezavisni prediktor mortaliteta tokom perioda praćenja od 48 meseci (HR 0.68; 95% CI 0.38–1.20; p = 0.182). Zaključak. Novonastala AF kod bolesnika sa MI bila je povezana sa povišenim mortalitetom odnosno MACCE tokom perioda praćenja od 48 meseci, ali nije bila nezavisni prediktor mortaliteta tokom ovog perioda.
Reference
Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: A systematic review of the inci-dence, clinical features and prognostic implications. Eur Heart J 2009; 30(9): 1038−45.
Lopes RD, Pieper KS, Horton JR, Al-Khatib SM, Newby LK, Mehta RH, et al. Short- and long-term outcomes following atrial fi-brillation in patients with acute coronary syndromes with or without ST-segment elevation. Heart 2008; 94(7): 867−73.
Pedersen OD, Bagger H, Køber L, Torp-Pedersen C. The occurrence and prognostic significance of atrial fibrillation/-flutter follow-ing acute myocardial infarction. TRACE Study group. TRAn-dolapril Cardiac Evalution. Eur Heart J 1999; 20(10): 748−54.
Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Mag-gioni AP, et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: The GISSI-3 data. Heart 2001; 86(5): 527−32.
Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM. Atrial fibrillation in the setting of acute myocardial infarc-tion: The GUSTO-I experience. Global Utilization of Strepto-kinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 1997; 30(2): 406−13.
Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: Prevalence and outcomes. Cir-culation 2000; 101(9): 969−74.
Al-Khatib SM, Pieper KS, Lee KL, Mahaffey KW, Hochman JS, Pepine CJ, et al. Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: Results from the PURSUIT trial. Am J Cardiol 2001; 88(1): A7, 76−9.
Sankaranarayanan R, James MA, Nuta B, Townsend M, Kesavan S, Burtchaell S, et al. Does atrial fibrillation beget ventricular fibril-lation in patients with acute myocardial infarction. Pacing Clin Electrophysiol 2008; 31(12): 1612−9.
Mehta RH, Dabbous OH, Granger CB, Kuznetsova P, Kline-Rogers EM, Anderson FA, et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrilla-tion. Am J Cardiol 2003; 92(9): 1031−6.
Goldberg RJ, Seeley D, Becker RC, Brady P, Chen ZY, Osganian V, et al. Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: A community-wide perspective. Am Heart J 1990; 119(5): 996−1001.
Madias JE, Patel DC, Singh D. Atrial fibrillation in acute myo-cardial infarction: A prospective study based on data from a consecutive series of patients admitted to the coronary care unit. Clin Cardiol 1996; 19(3): 180−6.
Sugiura T, Iwasaka T, Takahashi N, Nakamura S, Taniguchi H, Nagahama Y, et al. Atrial fibrillation in inferior wall Q-wave acute myocardial infarction. Am J Cardiol 1991; 67(13): 1135−6.
Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Steg G, James S, Atar D, Badano L, Borger M, Di Ma-rio C, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33(20): 2569−619.
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coro-nary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37(3): 267−315.
Laurent G, Zeller M, Dentan G, Moreau D, Laurent Y, Beer JC, et al. Prognostic impact of new onset atrial fibrillation in acute non-ST elevation myocardial infarction data from the RICO survey. Heart 2005; 91(3): 369−70.
Nabauer M, Gerth A, Limbourg T, Schneider S, Oeff M, Kirchhof P, et al. The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial manage-ment. Europace 2009; 11(4): 423−34.
Frost L, Benjamin E, Fenger-Gron M, Pederensen A, Tjonneland A, Overvad K. Body Fat, Body Fat Distribution, Lean Body Mass and Atrial Fibrillation and Flutter. A Danish Cohort Study. Obesity (Silver Sprint) 2014; 22(6): 1546−52.
Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of ob-esity on left ventricular mass and geometry. The Framingham Heart Study. JAMA 1991; 266(2): 231−6.
Schnabel RB, Kerr KF, Lubitz SA, Alkylbekova EL, Marcus GM, Sinner MF, et al. Large-scale candidate gene analysis in whites and African Americans identifies IL6R polymorphism in rela-tion to atrial fibrillation: The National Heart, Lung, and Blood Institute's Candidate Gene Association Resource (CARe) project. Circ Cardiovasc Genet 2011; 4(5): 557−64.
Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004; 110(4): 364−7.
Ravelli F, Allessie M. Effects of atrial dilatation on refractory period and vulnerability to atrial fibrillation in the isolated Langendorff-perfused rabbit heart. Circulation 1997; 96(5): 1686−95.
Aronson D, Goldsher N, Zukermann R, Kapeliovich M, Lessick J, Mutlak D, et al. Ischemic mitral regurgitation and risk of heart failure after myocardial infarction. Arch Intern Med 2006; 166(21): 2362−8.
Bursi F, Enriquez-Sarano M, Jacobsen SJ, Roger VL. Mitral regur-gitation after myocardial infarction: A review. Am J Med 2006; 119(2): 103−12.
Grigioni F, Detaint D, Avierinos JF, Scott C, Tajik J, Enriquez-Sarano M. Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction. J Am Coll Cardiol 2005; 45(2): 260−7.
Bahouth F, Mutlak D, Furman M, Musallam A, Hammerman H, Lessick J, et al. Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction. Heart 2010; 96(9): 683−8.
Siu CW, Jim M, Ho H, Miu R, Lee SW, Lau C, et al. Transient atrial fibrillation complicating acute inferior myocardial infarc-tion: implications for future risk of ischemic stroke. Chest 2007; 132(1): 44−9.
Koracevic GP, Petrovic S, Damjanovic M, Stanojlovic T. Association of stress hyperglycemia and atrial fibrillation in myocardial in-farction. Wien KlinWochenschr 2008; 120(13−14): 409−13.
Asanin M, Stankovic S, Mrdovic I, Matic D, Savic L, Majkic-Singh N, et al. B-type natriuretic peptide predicts new-onset atrial fi-brillation in patients with ST-segment elevation myocardial in-farction treated by primary percutaneous coronary interven-tion. Peptides 2012; 35(1): 74−7.
Mrdovic I, Savic L, Krljanac G, Perunicic J, Asanin M, Lasica R, et al. Incidence, predictors, and 30-day outcomes of new-onset atrial fibrillation after primary percutaneous coronary interven-tion: Insight into the RISK-PCI trial. Coron Artery Dis 2012; 23(1): 1−8.
Asanin MR, Milika AR, Vasiljevic ZM, Zorana VM, Matic MD, Mihailo MD, et al. The long-term risk of stroke in patients with acute myocardial infarction complicated with new-onset atrial fibrillation. Clin Cardiol 2009; 32(8): 467−70.
Asanin M, Perunicic J, Mrdovic I, Matic M, Vujisic-Tesic B, Arandje-lovic A, et al. Significance of recurrences of new atrial fibrillation in acute myocardial infarction. Int J Cardiol 2006; 109(2): 235−40.
Asanin M, Perunicic J, Mrdovic I, Matic M, Vujisic-Tesic B, Arandje-lovic A, et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial in-farction. Eur J Heart Fail 2005; 7(4): 671−6.