Long-Term Effect of Non-Selective Beta-Blockers in Patients With Rheumatoid Arthritis After Myocardial Infarction—A Nationwide Cohort Study

Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients.Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups.Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs.Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.

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Glucose variability and the risks of stroke, myocardial infarction, and all-cause mortality in individuals with diabetes: retrospective cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01134-0 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Da Young Lee ◽

Kyungdo Han ◽

Sanghyun Park ◽

Ji Hee Yu ◽

Ji A. Seo ◽

...

Keyword(s):

Myocardial Infarction ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

The Elderly ◽

Glucose Variability ◽

All Cause Mortality ◽

Nationwide Observational Study ◽

The Impact

Abstract Background Previous research regarding long-term glucose variability over several years which is an emerging indicator of glycemic control in diabetes showed several limitations. We investigated whether variability in long-term fasting plasma glucose (FG) can predict the development of stroke, myocardial infarction (MI), and all-cause mortality in patients with diabetes. Methods This is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. A total of 624,237 Koreans ≥ 20 years old with diabetes who had undergone health examinations at least twice from 2005 to 2008 and simultaneously more than once from 2009 to 2010 (baseline) without previous histories of stroke or MI. As a parameter of variability of FG, variability independent of mean (VIM) was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31, 2017. Results During follow-up, 25,038 cases of stroke, 15,832 cases of MI, and 44,716 deaths were identified. As the quartile of FG VIM increased, the risk of clinical outcomes serially increased after adjustment for confounding factors including duration and medications of diabetes and the mean FG. Adjusted hazard ratios (95% confidence intervals) of FG VIM quartile 4 compared with quartile 1 were 1.20 (1.16–1.24), 1.20 (1.15–1.25), and 1.32 (1.29–1.36) for stroke, MI and all-cause mortality, respectively. The impact of FG variability was higher in the elderly and those with a longer duration of diabetes and lower FG levels. Conclusions In diabetes, long-term glucose variability showed a dose–response relationship with the risk of stroke, MI, and all-cause mortality in this nationwide observational study.

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P3584Optimal medical therapy improves survival in patients with ischaemic cardiomyopathy: an analysis of the STICH trial

European Heart Journal ◽

10.1093/eurheartj/ehz745.0444 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N Wolfe ◽

J D Mitchell ◽

D L Brown

Keyword(s):

Clinical Trial ◽

Coronary Artery ◽

Medical Therapy ◽

Relative Reduction ◽

Term Survival ◽

Ischaemic Cardiomyopathy ◽

All Cause Mortality ◽

Stich Trial ◽

The Impact

Abstract Background Prior studies have demonstrated underuse of optimal medical therapy (OMT) in patients with coronary artery disease (CAD) after revascularization. However, there are limited studies assessing compliance with OMT on long-term survival in patients with CAD and no studies evaluating the impact of OMT in patients with severe CAD and reduced left ventricular (LV) function. The Surgical Treatment for Ischaemic Heart Failure (STICH) Trial was a randomized clinical trial that compared coronary-artery bypass grafting (CABG) with medical therapy versus medical therapy alone in the treatment of ischemic cardiomyopathy. Purpose This study sought to determine compliance with OMT over time and the impact of OMT compliance on survival in patients with or without revascularization. Methods STICH was a multicenter, randomized clinical trial of patients with an LV ejection fraction of 35% or less and CAD amenable to CABG who were randomized to CABG plus medical therapy (N=610) or medical therapy alone (N=602). A medication history was obtained at hospital discharge or 30 days after enrollment, 1 year, 5 years, and 10 years. OMT was defined as the combination of at least 1 antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The primary outcome was all-cause mortality. Comparison of mortality between the OMT and non-OMT groups was performed using multivariate Cox regression modeling with OMT as a time-dependent covariate. Results Of the 1212 patients randomized, at a median follow-up of 9.8 years, all-cause mortality was 58.9% in the CABG group and 66.1% in the medical therapy group. In the CABG arm, 63.6% of patients were on OMT throughout the study period compared to 66.5% of patients in the medical therapy arm (p=0.3). Those on OMT were younger (59.6 vs. 61.4 years, p<0.001); were more often in NYHA class I-II (67.4% vs. 56%, p<0.001); and lower rates of atrial fibrillation (9.4% vs. 18.1%, p<0.001), current smoking (18.6% vs. 24.5%, p=0.015), and depression (4.8% vs. 8.8%, p=0.005). Those on OMT had higher rates of hyperlipidemia (63.8% vs. 54.4%, p=0.001) and prior myocardial infarction (79.4% vs. 73.1%, p=0.01). There was no difference in sex, diabetes, and hypertension between those on OMT and non-OMT. In multivariate survival analysis, OMT was associated with a significant reduction in mortality (adjusted hazard ratio, 0.69; 95% confidence interval, 0.58–0.81; p<0.001). The treatment effect with OMT (31% relative reduction in mortality over 10 years) was numerically greater than the treatment effect of CABG (24% relative reduction in mortality with CABG versus medical therapy alone). Conclusions OMT improves long-term survival in patients with ischaemic cardiomyopathy regardless of revascularization status. Strategies to improve OMT use and adherence in this population is needed to maximize survival.

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Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620963030 ◽

2020 ◽

Vol 14 ◽

pp. 175346662096303

Author(s):

Hayoung Choi ◽

Hyun Lee ◽

Jiin Ryu ◽

Sung Jun Chung ◽

Dong Won Park ◽

...

Keyword(s):

Confidence Interval ◽

Respiratory Diseases ◽

Chronic Obstructive ◽

Study Cohort ◽

Limited Information ◽

Term Survival ◽

Obstructive Pulmonary Disease ◽

All Cause Mortality ◽

The Impact

Background: Long-term corticosteroid (CS) use is associated with increased mortality in patients with asthma, and comorbid bronchiectasis is also associated with frequent asthma exacerbation and increased healthcare use. However, there is limited information on whether bronchiectasis further increases mortality in patients with CS-dependent asthma. This study examined the impact of bronchiectasis on mortality in patients with CS-dependent asthma. Methods: A retrospective cohort of patients with CS-dependent asthma ⩾18 years old was established using records from the Korean National Health Insurance Service database from 2005 to 2015. Patients with CS-dependent asthma with and without bronchiectasis were matched by age, sex, type of insurance, and Charlson comorbidity index. We evaluated the hazard ratio (HR) for all-cause mortality in patients with bronchiectasis compared with those without bronchiectasis. Results: The study cohort included 754 patients with CS-dependent asthma with bronchiectasis and 3016 patients with CS-dependent asthma without bronchiectasis. Patients with CS-dependent asthma with bronchiectasis had a higher all-cause mortality than those without bronchiectasis (8429/100,000 versus 6962/100,000 person-years, p < 0.001). The adjusted HR for mortality in patients with CS-dependent asthma with bronchiectasis relative to those without bronchiectasis was 1.33 (95% confidence interval, 1.18–1.50), and the association was primarily significant for respiratory diseases (subdistribution HR = 1.65, 95% confidence interval, 1.42–1.92). Conclusions: Bronchiectasis further increases all-cause mortality in patients with CS-dependent asthma, a trend that was especially associated with respiratory diseases including chronic obstructive pulmonary disease. Strategies to improve treatment outcomes in patients with CS-dependent asthma with bronchiectasis are urgently needed to improve long-term survival. The reviews of this paper are available via the supplemental material section.

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Sociodemographic, labour market marginalisation and medical characteristics as risk factors for reinfarction and mortality within 1 year after a first acute myocardial infarction: a register-based cohort study of a working age population in Sweden

BMJ Open ◽

10.1136/bmjopen-2019-033616 ◽

2019 ◽

Vol 9 (12) ◽

pp. e033616

Author(s):

Mo Wang ◽

Marjan Vaez ◽

Thomas Ernst Dorner ◽

Syed Ghulam Rahman ◽

Magnus Helgesson ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cohort Study ◽

Labour Market ◽

Work Disability ◽

First Year ◽

Risk Of Mortality ◽

All Cause Mortality

ObjectivesResearch covering a wide range of risk factors related to the prognosis during the first year after an acute myocardial infarction (AMI) is insufficient. This study aimed to investigate whether sociodemographic, labour market marginalisation and medical characteristics before/at AMI were associated with subsequent reinfarction and all-cause mortality.DesignPopulation-based cohort study.ParticipantsThe cohort included 15 069 individuals aged 25–64 years who had a first AMI during 2008–2010.Primary and secondary outcome measuresThe outcome measures consisted of reinfarction and all-cause mortality within 1 year following an AMI, which were estimated by univariate and multivariable HRs and 95% CIs by Cox regression.ResultsSociodemographic characteristics such as lower education showed a 1.1-fold and 1.3-fold higher risk for reinfarction and mortality, respectively. Older age was associated with a higher risk of mortality while being born in non-European countries showed a lower risk of mortality. Labour market marginalisation such as previous long-term work disability was associated with a twofold higher risk of mortality. Regarding medical characteristics, ST-elevation myocardial infarction was predictive for reinfarction (HR: 1.14, 95% CI: 1.07 to 1.21) and all-cause mortality (HR: 3.80, 95% CI: 3.08 to 4.68). Moreover, diabetes mellitus, renal insufficiency, stroke, cancer and mental disorders were associated with a higher risk of mortality (range of HRs: 1.24–2.59).ConclusionsSociodemographic and medical risk factors were identified as risk factors for mortality and reinfarction after AMI, including older age, immigration status, somatic and mental comorbidities. Previous long-term work disability and infarction type provide useful information for predicting adverse outcomes after AMI during the first year, particularly for mortality.

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Associations Between Using Chinese Herbal Medicine and Long-Term Outcome Among Pre-dialysis Diabetic Nephropathy Patients: A Retrospective Population-Based Cohort Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.616522 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jenny Chun-Ling Guo ◽

Heng-Chih Pan ◽

Bo-Yan Yeh ◽

Yen Chu Lu ◽

Jiun-Liang Chen ◽

...

Keyword(s):

Herbal Medicine ◽

Chinese Herbal Medicine ◽

Lower Risk ◽

Population Based ◽

Term Outcome ◽

Long Term Outcome ◽

Chinese Herbal ◽

Risk Of Mortality ◽

All Cause Mortality

Background: Chronic kidney disease (CKD) has become a worldwide burden due to the high co-morbidity and mortality. Diabetic nephropathy (DN) is one of the leading causes of CKD, and pre-dialysis is one of the most critical stages before the end-stage renal disease (ESRD). Although Chinese herbal medicine (CHM) use is not uncommon, the feasibility of using CHM among pre-dialysis DN patients remains unclear.Materials and methods: We analyzed a population-based cohort, retrieved from Taiwan’s National Health Insurance Research Database, to study the long-term outcome of using CHM among incident pre-dialysis DN patients from January 1, 2004, to December 31, 2007. All patients were followed up to 5 years or the occurrence of mortality. The risks of all-cause mortality and ESRD were carried out using Kaplan-Meier and competing risk estimation, respectively. Further, we demonstrated the CHM prescriptions and core CHMs using the Chinese herbal medicine network (CMN) analysis.Results: A total of 6,648 incident pre-dialysis DN patients were analyzed, including 877 CHM users and 5,771 CHM nonusers. With overlap weighing for balancing all accessible covariates between CHM users and nonusers, we found the use of CHM was associated with lower all-cause mortality (0.22 versus 0.56; log-rank test: p-value <0.001), and the risk of mortality was 0.42 (95% CI: 0.36–0.49; p-value <0.001) by adjusting all accessible covariates. Further, the use of CHM was associated with a lower risk of ESRD (cause-specific hazard ratio: 0.59, 95%CI: 0.55–0.63; p-value <0.001). Also, from the 5,901 CHM prescriptions, we found Ji-Sheng-Shen-Qi-Wan, Astragalus mongholicus Bunge or (Astragalus membranaceus (Fisch.) Bge.), Plantago asiatica L. (or Plantago depressa Willd.), Salvia miltiorrhiza Bunge, and Rheum palmatum L. (or Rheum tanguticum (Maxim. ex Regel) Balf., Rheum officinale Baill.) were used as core CHMs for different CHM indications. Use of core CHMs was associated with a lower risk of mortality than CHM users without using core CHMs.Conclusions: The use of CHM seemed feasible among pre-dialysis DN patients; however, the beneficial effects still need to be validated by well-designed clinical trials.

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The Effect of Smoking on the Relationship between Alcohol Consumption and All-Cause Mortality in Canadian Women

Contemporary Drug Problems ◽

10.1177/009145090503200303 ◽

2005 ◽

Vol 32 (3) ◽

pp. 373-386

Author(s):

Jürgen Rehm ◽

Bo Zhang ◽

Susan Bondy ◽

Mary Jane Ashley ◽

Joanna Cohen ◽

...

Keyword(s):

Alcohol Consumption ◽

Protective Effect ◽

Lower Risk ◽

Smoking Status ◽

Moderate Drinking ◽

Risk Of Mortality ◽

Heavy Drinkers ◽

All Cause Mortality ◽

The Relationship ◽

Effect Of Light

The protective effect of light to moderate drinking on all-cause mortality in general is well established, but there have been questions on its generalizability to women and non-smokers. The present study addresses these questions with a large cohort of Canadian middle-aged women. The key findings indicate that light to moderate drinkers have a markedly lower risk of mortality compared with current abstainers and that this effect is independent of smoking status. Part of this effect may be due to ex-drinkers who are part of the current abstainers group. Heavy drinkers have a higher mortality risk than light to moderate drinkers.

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Hyperlipidemia and mortality associated with diabetes mellitus co-existence in Chinese peritoneal dialysis patients

Lipids in Health and Disease ◽

10.1186/s12944-020-01405-5 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Xin Wei ◽

Yueqiang Wen ◽

Qian Zhou ◽

Xiaoran Feng ◽

Fen Fen Peng ◽

...

Keyword(s):

Diabetes Mellitus ◽

Peritoneal Dialysis ◽

Cox Regression ◽

Dialysis Patients ◽

Term Survival ◽

Risk Of Mortality ◽

Subgroup Analyses ◽

All Cause Mortality

Abstract Background To evaluate associations between diabetes mellitus (DM) coexisting with hyperlipidemia and mortality in peritoneal dialysis (PD) patients. Methods This was a retrospective cohort study with 2939 incident PD patients in China from January 2005 to December 2018. Associations between the DM coexisting with hyperlipidemia and mortality were evaluated using the Cox regression. Results Of 2939 patients, with a median age of 50.0 years, 519 (17.7%) died during the median of 35.1 months. DM coexisting with hyperlipidemia, DM, and hyperlipidemia were associated with 1.93 (95% CI 1.45 to 2.56), 1.86 (95% CI 1.49 to 2.32), and 0.90 (95% CI 0.66 to 1.24)-time higher risk of all-cause mortality, compared with without DM and hyperlipidemia, respectively (P for trend < 0.001). Subgroup analyses showed a similar pattern. Among DM patients, hyperlipidemia was as a high risk of mortality as non-hyperlipidemia (hazard ratio 1.02, 95%CI 0.73 to 1.43) during the overall follow-up period, but from 48-month follow-up onwards, hyperlipidemia patients had 3.60 (95%CI 1.62 to 8.01)-fold higher risk of all-cause mortality than those non-hyperlipidemia (P interaction = 1.000). Conclusions PD patients with DM coexisting with hyperlipidemia were at the highest risk of all-cause mortality, followed by DM patients and hyperlipidemia patients, and hyperlipidemia may have an adverse effect on long-term survival in DM patients.

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Impact of Prosthesis-Patient Mismatch on Survival after Mitral Valve Replacement: A Meta-analysis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1675195 ◽

2018 ◽

Vol 67 (07) ◽

pp. 538-545 ◽

Cited By ~ 1

Author(s):

Ho-Young Hwang ◽

Suk-Ho Sohn ◽

Myoung-jin Jang

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Odds Ratio ◽

Meta Analysis ◽

Early Mortality ◽

Term Survival ◽

Subgroup Analyses ◽

All Cause Mortality ◽

The Impact

Background Numerous studies have demonstrated a negative impact of prosthesis-patient mismatch (PPM) on long-term clinical outcomes after aortic valve replacement. However, the impact of PPM after mitral valve replacement (MVR) on clinical outcomes is still controversial. This study was conducted to evaluate the impact of PPM on early and long-term survival after MVR. Methods A literature search of five databases was performed. The primary and secondary outcomes were all-cause mortality and early mortality, respectively. Subgroup analyses were performed according to the risk of bias, patients' age, proportion of female patients, and proportion of patients with mechanical MVR. Results Eleven nonrandomized studies including 8,072 patients were included in this meta-analysis. The overall incidence of PPM was 58.0% (range: 10.4–85.9%). The odds ratio of early mortality in nine studies was not significantly different between the PPM and non-PPM patients (odds ratio: 1.35; 95% confidence interval [CI]: 0.98–1.86). A pooled analysis in 11 studies demonstrated that all-cause mortality after MVR was higher in the PPM than non-PPM patients (hazard ratio [HR]: 1.39; 95% CI: 1.09–1.77). This analysis revealed a moderate to high heterogeneity (I 2 = 69.4%). When pooled analyses were performed in two subgroups according to the proportion of patients with mechanical MVR, there were low heterogeneity in each group. No other subgroup analyses demonstrated a significant difference in the HR of all-cause mortality. Funnel plots and Egger's tests showed no visually and statistically significant publication bias. Conclusion The present meta-analysis indicates that PPM negatively affects long-term survival after MVR.

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Long-term survival after a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction and long distances to primary percutaneous coronary intervention – a prospective cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.1455 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

K M Kvakkestad ◽

J M Gran ◽

S Halvorsen

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Propensity Score ◽

Lower Risk ◽

Coronary Intervention ◽

Term Survival ◽

Percutaneous Coronary ◽

St Elevation

Abstract Background In patients with ST-elevation myocardial infarction (STEMI), a pharmacoinvasive (PI) strategy is the recommended reperfusion method if primary percutaneous coronary intervention (pPCI) cannot be performed within 120 minutes from diagnosis. Long-term prognosis for STEMI patients with long transfer distances to pPCI is sparsely documented. Purpose To compare short- and long-term survival, and cardiovascular (CV) death in STEMI patients treated with PI or pPCI strategy. Methods Consecutive STEMI patients admitted to our cardiac invasive centre were registered prospectively during 2005–2011 in a local quality registry. Follow-up data throughout 2013 were provided by the Norwegian Cause of death registry. Effects of treatment strategy were determined using a propensity score weighted analysis, adjusting for treatment-outcome confounding. Outcomes were 30-day mortality, overall survival and CV death during follow-up. Results Of 4762 STEMI patients, 543 (11.4%) were treated with thrombolysis before admission for rescue- or early coronary angiography (PI strategy), and 4044 (84.9%) were admitted for a pPCI strategy (3,7% excluded due to unspecified treatment strategy). Median age was 60 and 63 years in the PI and pPCI groups (19.5% and 24.1% women, respectively). Median time to reperfusion was 110 minutes (25–75th percentile: 75–163; symptom-to-thrombolysis) versus 230 minutes (149–435; symptom-to-balloon). Crude 30-day mortality was 3.9% and 6.6% in the PI- and pPCI groups. Median follow-up was 4.5 years (max 8.3 years). The overall 8-year survival was 84.6% (95% CI 79.4–88.4) in the PI group and 72.6% (95% CI 70.1–74.9) in the pPCI group (crude hazard ratio [HR] 0.56 (95% CI 0.43–0.72, p<0.0001). After propensity score weighting (based on age, gender, smoking, previous hypertension, stroke, diabetes, myocardial infarction, angina pectoris and peripheral artery disease, kidney function and pre-hospital resuscitation), patients had estimated 25% lower risk of long-term mortality with a PI strategy (weighted HR 0.75; 95% CI 0.53–1.07, p=0.113, Figure 1A). Cumulative incidence rate of CV death was 12.8 (PI strategy) and 27.8 (pPCI strategy) pr 1000 person-years (crude incidence rate ratio 0.46; 95% CI 0.32–0.68, p<0.0001), and was significantly lower in the PI group after weighting on the propensity score (p=0.048, Figure 1B). Conclusions There was a non-significant 25% lower risk of mortality up to 8 years with a PI versus pPCI strategy in STEMI patients with long transfer distances to PCI, after adjustment for treatment-outcome confounding. Importantly, long-term incidence of CV death was significantly lower in the PI group. These findings from real life practice support the use of a PI strategy in STEMI patients without contraindications to thrombolysis, when pPCI within 120 minutes from diagnosis is not possible. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by grant form the Scientific Board of the Southeastern Norway Regional Health Authority, Hamar, Norway.

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Prognostic Impact of the Symptom of New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Insights From the NOAFCAMI-SH Registry

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.677695 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiachen Luo ◽

Baoxin Liu ◽

Hongqiang Li ◽

Siling Xu ◽

Mengmeng Gong ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Prognostic Impact ◽

Term Survival ◽

All Cause Mortality ◽

Onset Atrial Fibrillation ◽

New Onset

Background: New-onset atrial fibrillation (NOAF) is a common complication during acute myocardial infarction (AMI) and sometimes can be completely asymptomatic, but the clinical implications of these asymptomatic episodes require further characterization. The objective of this study was to investigate the short- and long-term prognostic impact of post-MI NOAF based on the presence of AF-related symptoms.Methods: The New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai (NOAFCAMI-SH) registry was a retrospective cohort including participants with AMI without a documented history of AF. Patients with NOAF were divided into two groups according to the AF-related symptoms. The primary endpoint was all-cause mortality.Results: Of 2,399 patients included, 278 (11.6%) developed NOAF of whom 145 (6.0%) with asymptomatic episodes and 133 (5.5%) with symptomatic ones. During hospitalization, 148 patients died [106, 10, and 32 in the sinus rhythm (SR), asymptomatic, and symptomatic NOAF groups, respectively]. After multivariable adjustment, only symptomatic NOAF was associated with in-hospital mortality [odds ratio (OR): 2.32, 95% confidence interval (CI): 1.36–3.94] compared with SR. Over a median follow-up of 2.7 years, all-cause mortality was 3.2, 12.4, and 11.8% per year in the SR, asymptomatic, and symptomatic NOAF groups, respectively. After adjustment for confounders, it was the asymptomatic NOAF [hazard ratio (HR): 1.61, 95% CI: 1.09–2.37) rather than the symptomatic one (HR: 1.37, 95% CI: 0.88–2.12) that was significantly related to mortality. Similar results were also observed for cardiovascular mortality [HRs and 95% CI were 1.71 (1.10–2.67) and 1.25 (0.74–2.11) for asymptomatic and symptomatic NOAF, respectively]. Both asymptomatic and symptomatic NOAF episodes were associated with heart failure, whereas only those with symptomatic NOAF were at heightened risk of ischemic stroke. Our exploratory analysis further identified patients with asymptomatic high-burden NOAF as the highest-risk population (mortality: 19.6% per year).Conclusion: Among patients with AMI, symptomatic NOAF is related to in-hospital mortality and asymptomatic NOAF is associated with poor long-term survival.Registration: URL: https://clinicaltrials.gov/; Unique identifier: NCT03533543.

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