scholarly journals Prognostic value of atrial fibrillation in group of patients with myocardial infarction. Long-term observation results

2021 ◽  
Vol 26 (2) ◽  
pp. 4285
Author(s):  
M. V Soloveva ◽  
S. A. Boldueva
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Control Group ◽  
Minor Bleeding ◽  
Cardiology Department ◽  
Long Term Prognosis ◽  
Long Term Observation ◽  
Significant Factors

Purpose. To assess the effect of preexisting atrial fibrillation (AF) on prognosis in patients with type 1 myocardial infarction (MI).Material and methods. These patients were selected from 1660 patients with MI admitted to cardiology department of the NWSMU named after I.I. Mechnikov in 2013-2018. They formed the main group (100 patients). The control group included 200 patients with type 1 MI without AF with the same gender, age. In order to balance groups by prognostically significant factors propensity score matching was carried out. Тhen effect of AF on endpoints was assessed.Results. Patients with type 1 MI and preexisting AF have higher comorbidity, lower ejection fraction. In this group in-hospital pulmonary embolism (PE) (9 % versus 1 % in patients without AF, p=0,0011), minor bleeding (21 % versus 9,5 %, p=0,0057), combined endpoint (stroke + PE + mortality) (19 % versus 10,5 %, p=0,0415) were more common. In the long-term period patients with AF had a higher rate of hospitalizations due to decompensation of chronic heart failure (CHF) (OR=2,47 (95 % CI =1,20–5,08), p=0,0137) and higher incidence of minor bleeding (OR=10,77 (95 % CI =2,36–49,24), p=0,0022). Preexisting AF in patients with type 1 MI (after adjustment for prognostically significant factors) increased the risk of all-cause (OR=5,0 (95 % CI =1,5-17,1), p=0,0072) and cardiovascular mortality (OR=4,1 (95 % CI =1,1-14,9), p=0,0236), increased the risk of CHF III-IV (OR=4,9 (95 % CI =1,2–20,4), p=0,0147), but had no effect on the frequency of ischemic events.Сonclusion. In patients with type 1 MI and pre-existing AF in-hospital and long-term prognosis is worse than in patients without AF. Preexisting AF in these patients is an independent predictor of severe CHF at discharge, cardiovascular and all-cause mortality over follow-up period.

scholarly journals Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments

2020 ◽  
Vol 10 (1) ◽  
pp. 106
Author(s):  
Anton Gard ◽  
Bertil Lindahl ◽  
Nermin Hadziosmanovic ◽  
Tomasz Baron
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Cardiology Department ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
Long Term Prognosis ◽  
One Year

Aim: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. Methods: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. Results: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62–3.22), one year (HR 1.82; 95% CI 1.39–2.36) and five years (HR 1.62; 95% CI 1.32–1.98). Conclusions: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.

scholarly journals The evaluation of in-hospital prognosis of patient with myocardial infarction and atrial fibrillation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
M Solovyeva ◽  
S Boldueva
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Main Group ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Minor Bleeding ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients

Abstract Funding Acknowledgements Type of funding sources: None. Purpose  to assess the incidence of various forms of atrial fibrillation (AF) among the patients with MI, the prevalence of various types of myocardial infarction (MI) among the patients with AF, the features of the in-hospital prognosis among the patients with MI, and AF compared with those without AF. Materials and methods  1660 cases of patients with MI treated in 2013-18 - the main group (100 patients) were analyzed.  Results  AF occurred in 309 patients (18.6% of the total number of patients with MI). Preexisting AF was in 59.2% of patients. Patients with MI and AF were older than those without AF (mean age 75.2 ± 10.1 versus 64.6 ± 12.8, p <0.0001), among them there were more women (52.4% versus 35.5% in patients without AF, p <0.0001). Type 2 MI occurred 5 times more often among patients with MI and AF (p <0.0001). Further, 2 study groups were formed - the main (100 patients with type 1 MI and preexisting AF) and control (type 1 MI 200 patients without AF), adjusted for sex (58% of women in both groups), age (mean age 75.5 ± 8, 7 in the main group versus 75.2 ± 8.5 in the control group, p = 0.775). DM (45% versus 31.5%, p = 0.030), previous MI (40% versus 25.5%, p = 0.012) and stroke (21% vs. 11.5%, p = 0.037) were more common in the main group than in the control. Patients with MI and AF had lower GFR (56.8 ± 19.4 versus 61.7 ± 17.9 ml / min / 1.73 m2, p = 0.031), LDL (2.8 ± 0.9 versus 3.3 ± 1.0 mmol/L, p = 0.0002). Patients with AF had a lower left ventricular ejection fraction (55.2 ± 10.5 versus 59.8 ± 10.0 %, p = 0.0005). Significant mitral regurgitation was more common in the 1-st group (53.9% versus 30.3% in the control group, p = 0.0002). There were no significant differences in the incidence of acute heart failure (HF) (Killip 3-4) (20% versus 13%, p = 0.127). Patients in the 1-st and 2-nd groups did not differ in the number of affected coronary artery (p = 0.7327), the level of their damage (p = 0.1956), in the frequency of revascularization (p = 0.0686). Patients with MI and AF had worse in-hospital prognosis. Pulmonary embolism (PE) (9% in patients with AF versus 1% in patients without AF, p = 0.0011), minor bleeding (21% versus 9.5%, p = 0.0057), combined endpoint (stroke + PE + mortality) (19% versus 10.5%, p = 0.0415) were more common in the main group. At discharge, patients with AF had chronic HF III NYHA in 21.8% cases versus 5.5% in patients without AF, p = 0.0001. There were no significant differences in other endpoints (recurrent MI, stroke, major bleeding, and total mortality) between the groups during hospitalization. In-hospital mortality was 13% in the main versus 9.5% in the control group (p = 0.4276). Conclusion  AF occurs in 18.6% of patients with MI. Patients with AF and MI are older with the prevalence of females. Patients with type 1 MI and pre-existing AF is a group of high risk. PE, severe chronic HF, minor bleeding, and combined endpoint (stroke + PE + mortality) were significantly common among them.

scholarly journals Antithrombotic therapy and its impact on prognosis in patients with atrial fibrillation and myocardial infarction. Long-term observation results

2021 ◽  
Vol 12 (3) ◽  
pp. 158-165
Author(s):  
Mariia V. Soloveva ◽  
Svetlana A. Boldueva
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Vitamin K ◽  
Antithrombotic Therapy ◽  
Vitamin K Antagonists ◽  
Exclusion Criterion ◽  
Hemorrhagic Events ◽  
Long Term Observation

Aim. To study antithrombotic therapy (ATT) in patients with myocardial infarction (MI) type 1 and preexisting atrial fibrillation (AF), effect of ATT on prognosis. Material and methods. 100 patients with type 1 MI and preexisting AF were selected. The exclusion criterion was severe concomitant pathology. Results. Only 13.0% of AF patients took anticoagulants (AC) adequately before hospitalization. 94.0% of patients in hospital and 80.5% at discharge were prescribed triple ATT at least for 1 month with transition to dual ATT (AC + disaggregant) for 12 months. ACs were prescribed in hospital in 100.0% of cases, at discharge in 93.1%. After 1 year 8.4% of patients stopped taking ACs, after 2.31.9 years 15.7%. The incidence of ischemic and hemorrhagic events didnt differ in patients with different regimens of ATT (double/triple) and types of AСs (vitamin K antagonists/non-vitamin K antagonist ACs). In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had increased risks of stroke (OR 9.580; 95% CI 1.15379.599, p=0.0365); combined endpoint: recurrent MI + stroke + cardiovascular mortality (OR 2.556; 95% CI 1.1045.918, p=0.0284). Сonclusion. Patients with preexisting AF had a low adherence to ACs prior to MI. It increased after hospitalization and decreased during follow-up. In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had significantly increased risks of stroke, combined endpoint. There were no differences in the prognosis depending on the type of ACs, the regimens of ATT administered in accordance with ischemic and hemorrhagic risks.

scholarly journals In-hospital prognosis in patients with myocardial infarction and atrial fibrillation

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
M Solovyeva ◽  
S Boldueva ◽  
E Bykova
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Main Group ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Minor Bleeding ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The number of patients with myocardial infarction (MI) and atrial fibrillation (AF) is increasing every year. Purpose to assess the incidence of AF among the patients with MI, the features of the in-hospital prognosis among the patients with MI and AF compared with MI without AF. Methods The patients with type 1 MI and preexisting AF have been selected from all MI patients MI admitted in 2013-18. They have formed the main group (100 patients). The control group (200 patients with type 1 MI without AF), has been created by "pair selection" method. Patients in the groups did not differ in gender, age, MI date and had not severe comorbidities. Results 1660 patients with MI were analyzed. AF occurred in 309 patients (18.6% of patients with MI). Preexisting AF was in 59.2%. Patients with MI and AF were older than MI without AF (mean age 75.2 ± 10.1 versus 64.6 ± 12.8, p <0.0001) with women’s prevalence (52.4% versus 35.5%, p <0.0001). Type 1 MI predominates among all patients. Type 2 MI occurred 5 times more often among main group (p <0.0001). 2 groups were adjusted for sex (58% of women in both groups), age (mean age 75.5 ± 8, 7 in the main versus 75.2 ± 8.5 in the control group, p = 0.775). Diabetes (45% versus 31.5%, p = 0.030), previous MI (40% versus 25.5%, p = 0.012) and stroke (21% versus 11.5%, p = 0.037) were more common in the main than in the control. Patients with MI and AF had lower GFR (56.8 ± 19.4 versus 61.7 ± 17.9 ml/min/1.73 m2, p = 0.031), LDL (2.8 ± 0.9 versus 3.3 ± 1.0 mmol/L, p = 0.0002). Patients with AF had a lower left ventricular ejection fraction (55.2 ± 10.5 versus 59.8 ± 10.0 %, p = 0.0005). Significant mitral regurgitation was more common in the main group (53.9% versus 30.3% in the control group, p = 0.0002). There were no differences in the incidence of acute heart failure (HF) Killip’s 3-4 (20% versus 13%, p = 0.127). Patients did not differ in the number of affected coronary artery (p = 0.7327), the level of stenosis (p = 0.1956), in the frequency of revascularization (p = 0.0686). Patients with MI and AF had worse in-hospital prognosis. Pulmonary embolism (PE) (9% in main versus 1% in control group, p = 0.0011), minor bleeding (21% versus 9.5%, p = 0.0057), combined endpoint (stroke + PE + mortality) (19% versus 10.5%, p = 0.0415) were more common in the main group. At discharge, patients with AF had HF III NYHA in 21.8% cases versus 5.5% in patients without AF, p = 0.0001. There were no significant differences in other in-hospital endpoints (recurrent myocardial infarction, stroke, major bleeding, and mortality) between the groups. In-hospital mortality was 13% in the main versus 9.5% in the control group (p = 0.4276). Conclusion AF occurs in 18.6% of patients with MI. Patients with AF and MI are older with female prevalence. Type 1 MI predominates. Patients with type 1 MI and pre-existing AF is a group of high risk because of more severe HF, PE, minor bleeding and combined endpoint (stroke + PE + mortality)

scholarly journals Clinical and pathogenetic features of myocardial infarction in patients with atrial fibrillation

2020 ◽  
pp. 31-39
Author(s):  
S.Y. Borodashkina ◽  
◽  
K.V. Protasov ◽  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Observational Studies ◽  
Risk Group ◽  
Clinical Manifestations ◽  
High Risk Group ◽  
Short Term ◽  
Invasive Treatment ◽  
Long Term Prognosis

Patients with myocardial infarction (MI) and atrial fibrillation (AF), the number of which is progressively increasing every year, make up a high-risk group for both recurrent cardiovascular events and bleeding; they require special attention from clinicians. The literature review provides data on features of pathogenesis and clinical manifestations of MI in patients with AF. The analysis of data on AF effect observational studies on short-term and long-term prognosis in patients with myocardial infarction was carried out. Mechanisms of occurrence, clinical features and prognostic value of postinfarction AF are considered. From the standpoint of modern clinical guidelines, information is presented on features of MI invasive treatment in combination with AF. Algorithms of anticoagulant and antiarrhythmic therapy in patients of this category are considered.

scholarly journals Association Between Fasting Hyperglycemia and New-Onset Atrial Fibrillation in Patients With Acute Myocardial Infarction and the Impact on Short- and Long-Term Prognosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Mingxing Li ◽  
Yingying Gao ◽  
Kai Guo ◽  
Zidi Wu ◽  
Yi Lao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
All Cause Mortality ◽  
Long Term Prognosis ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: The relationship between fasting hyperglycemia (FHG) and new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI) is unclear, and whether their co-occurrence is associated with a worse in-hospital and long-term prognosis than FHG or AF alone is unknown.Objective: To explore the correlation between FHG and new-onset AF in patients with AMI, and their impact on in-hospital and long-term all-cause mortality.Methods: We performed a retrospective cohort study comprising 563 AMI patients. The patients were divided into the FHG group and the NFHG group. The incidence of new-onset AF during hospitalization was compared between the two groups and sub-groups under different Killip grades. Logistic regression was used to assess the association between FHG and new-onset AF. In-hospital mortality and long-term all-cause mortality were compared among patients with FHG, AF, and with both FHG and AF according to 10 years of follow-up information.Results: New-onset AF occurred more frequently in the FHG group than in the NFHG group (21.6 vs. 9.2%, p < 0.001). This trend was observed for Killip grade I (16.6 vs. 6.5%, p = 0.002) and Grade II (17.1 vs. 6.9%, p = 0.005), but not for Killip grade III–IV (40 vs. 33.3%, p = 0.761). Logistic regression showed FHG independently correlated with new-onset AF (OR, 2.56; 95% CI, 1.53–4.30; P < 0.001), and 1 mmol/L increased in fasting glucose was associated with a 5% higher rate of new-onset AF, after adjustment for traditional AF risk factors. AMI patients complicated with both fasting hyperglycemia and AF showed the highest in-hospital mortality and long-term all-cause mortality during an average of 11.2 years of follow-up. Multivariate Cox regression showed FHG combined with AF independently correlated with long-term all-cause mortality after adjustment for other traditional risk factors (OR = 3.13, 95% CI 1.64–5.96, p = 0.001), compared with the group with neither FHG nor new-onset AF.Conclusion: FHG was an independent risk factor for new-onset AF in patients with AMI. AMI patients complicated with both FHG and new-onset AF showed worse in-hospital and long-term all-cause mortality than with FHG or AF alone.

scholarly journals Key factors of inflammation and long-term prognosis in patients with myocardial infarction and visceral obesity

2020 ◽  
pp. 77-82
Author(s):  
E. G. Uchasova ◽  
E. V. Belik ◽  
O. V. Gruzdeva ◽  
Y. A. Dileva ◽  
A. A. Kuzmina
Keyword(s):  
Myocardial Infarction ◽  
Vascular Complications ◽  
Visceral Obesity ◽  
Control Group ◽  
Key Factors ◽  
Reactive Protein ◽  
Long Term Prognosis ◽  
Cardio Vascular ◽  
Factor Α

Objective: To assess the relation between key factors of inflammation and myocardial infarction complications in different stages of the diseases in patients with visceral obesity.Methods: Men with the diagnosed myocardial infarction were examined: 64 of them with visceral obesity (the first group) and 30 of them without visceral obesity (the second group). On the 1s t and 12th day of hospitalization, the serum concentrations of interleukins (IL) 1β, 6, 8, 10 and 12, tumor necrosis factor α (TNFα) and C-reactive protein (CRP) were determined. The control group included 30 healthy men.Results: The cytokine profile in visceral obesity was characterized by the increase in concentration of proinflammatory ILs and the decrease in concentration of IL-10. The concentration increase was: 1.3 times for IL-1 and TNFα, 2 times for IL-12, 6 times for IL-6 and 24 times for IL-8 and CRP. The increase in IL-6 and CPR levels in blood serum was associated with the obesity.Conclusions: The development of adverse cardio‑ vascular complications a year later after the previous myocardial infarction is typical for patients with visceral obesity and is followed by the activation of proinflammatory cytokines and deficiency of IL-10. 

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