Journal of Geriatric Cardiology (2017) 14: 153154 ©2017 JGC All rights reserved; www.jgc301.com
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Recurrent acute myocardial infarction and atrial fibrillation Levent Cerit Department of Cardiology, Near East University, Nicosia, Cyprus. E-mail:
[email protected]
J Geriatr Cardiol 2017; 14: 153154. doi:10.11909/j.issn.1671-5411.2017.02.010 Keywords: Acute myocardial infarction; Age; Atrial fibrillation; Diabetes mellitus
I have read the article entitled Predictors and in-hospital prognosis of recurrent acute myocardial infarction by Cao, et al.[1] with great interest, recently published in journal. The investigators reported that recurrent acute myocardial infarction (AMI) patients presented with more severe coronary artery conditions. Age, diabetes mellitus (DM) and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AMI was related with a high risk of in-hospital death.[1] AMI is often complicated with cardiac arrhythmias, and the most common cardiac arrhythmia is atrial fibrillation (AF).[2] Post-infarction AF is associated with an increased, cardiogenic shock, pulmonary oedema, and re-infarction rate.[3] Prevalence of AF increases strikingly with advancing age, ranging from less than 0.5% of the population younger than 40% to 5% of those aged 65 and older and more than 10% of those surviving to the eighth decades of life.[4] A recent meta-analysis of cohort and case control study showed that patients with DM had an approximately 40% greater risk of AF, but this varied from 70% in studies adjusted only for age and sex to 24% in those adjusted for more variables.[5]
In this context, considering association between postinfarct AF and worse outcomes, correlation of this result[1] with post-infarct AF might be beneficial.
References 1
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Cao CF, Li SF, Chen H, et al. Predictors and in-hospital prognosis of recurrent acute myocardial infarction. J Geriatr Cardiol 2016; 13: 836–839. Bloch Thomsen PE, Jons C, Raatikainen MJP, et al. Longterm recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study. Circulation 2010; 122: 1258–1264. Mehta RH, Dabbous OH, Granger CB, et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. Am J Cardiol 2003; 92: 1031–1036 Stepanyan G, Gerstenfeld EP. Atrial fibrillation ablation in octogenarians: where do we stand? Curr Cardiol Rep 2013; 15: 406. Huxley RR, Filion KB, Konety S, et al. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011; 108: 56–62.
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Cheng-Fu CAO1,2,3, Su-Fang LI1,2,3, Hong CHEN1,2,3, Jun-Xian SONG1,2,3 1
Department of Cardiology, Peking University People’s Hospital, Beijing, China Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China 3 Center for Cardiovascular Translational Research, Peking University People’s Hospital, Beijing, China 2
Our article entitled Predictors and in-hospital prognosis of recurrent acute myocardial infarction reported that age, diabetes mellitus and reperfusion therapy were independent risk factors for recurrent acute myocardial infarction (AMI),
and recurrent AMI was related with a negative prognosis.[1] The focus of this article were recurrent AMI and its impacts, given that this article was not designed to capture many details of atrial fibrillation (AF) and its impacts on AMI prog-
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Levent Cerit, et al. Recurrent acute myocardial infarction and atrial fibrillation
nosis, we unfortunately did not have data about the heart rhythm of the patients. Just as Prof. Levent Cerit addressed, AF was very common in AMI patients. It was reported that AF occurred in 3% to 11% of patients with acute ST-segment elevation myocardial infarction.[2,3] The China Acute Myocardial Infarction (CAMI) registry showed that the overall incidence of AF was 3.0% in Chinese patients with AMI during hospitalization.[4] Compared with AMI patients without AF, patients with new-onset AF had higher rates of net adverse clinical events, mortality, reinfarction, stroke, and major bleeding. AF was a strong independent predictor and associated with increased in-hospital and long term mortality rates. In addition, HORIZONS-AMI trial reported that AMI patients with new-onset AF had significantly higher rates of ischemic events, including reinfarction and definite or probable stent thrombosis.[5]
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References 1
Cao CF, Li SF, Chen H, et al. Predictors and in-hospital
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prognosis of recurrent acute myocardial infarction. J Geriatr Cardiol 2016; 13: 836–839. Beukema RJ, Elvan A, Ottervanger JP, et al. Atrial fibrillation after but not before primary angioplasty for ST-segment elevation myocardial infarction of prognostic importance. Neth Heart J 2012; 20: 155–160. Lin CJ, Liu CF, Kung CT, et al. The prognostic value of atrial fibrillation on 30-day clinical outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int Heart J 2011; 52: 153–158. Dai Y, Yang J, Gao Z, et al. Atrial fibrillation in patients hospitalized with acute myocardial infarction: analysis of the china acute myocardial infarction (CAMI) registry. BMC Cardiovasc Disord 2017; 17: 2–8. Rene AG, Généreux P, Ezekowitz M, et al. Impact of atrial fibrillation in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention [from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial]. Am J Cardiol 2014; 113: 236–242.
