SPC365

New-onset of atrial fibrillation in ST-Elevation Myocardial Infarction

Session: Comunicações Orais (Sessão 18) - Doença Coronária e Cuidados Intensivos 4 - Risco e Prognóstico
Speaker: Hélder Santos

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Helder Santos; Mariana Santos; Sofia b. Paula; Inês Almeida; Samuel Almeida; Lurdes Almeida

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">ST-Elevation Myocardial Infarction (STEMI) is a major health problem, that without an emergency reperfusion therapy is associated with a worse prognosis. Nevertheless, in some cases, this pathology can be accompanied by other diseases, for example, atrial fibrillation (AF). AF presence at admission can be interpreted as an early and hemodynamic response to STEMI, yet after 48 hours its significance is not completed clarified.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Objective:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Evaluate differences between early and late new-onset AF in STEMI patients.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. New-onset AF was defined as the first episode of AF in patients without a history of AF and if occurred during the hospitalization for ACS. Patients were divided into two groups: A) early new onset of AF (first 48h after the initial electrocardiogram); B) late new onset of AF, more than 48 hours after the electrocardiogram.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> A total of 29851 patients was analyze and 501 patients presented new-onset of AF during the hospitalization for STEMI, 332 in group A (66.3%) and 169 in group B (33.7%). Both groups were similar regarding gender, body mass index , arterial hypertension, dyslipidemia,&nbsp;diabetes mellitus, coronary artery disease, stroke history, peripheral artery disease, chronic kidney disease, Killip-Kimball class &gt;I, creatinine at admission, glycemia levels at admission, HbA1c, platelet count, cholesterol levels, re-infarction as complication, STEMI mechanical complication, stroke as a STEMI complication&nbsp;and hospitalization death. Group A was directly admitted more frequent in the Cat lab (36.6 vs 26.2%, <em>p</em>=0.020), had more smokers (29.3 vs 18.0%, <em>p</em>=0.006), hemoglobin at admission (13.7&plusmn;1.8 vs 13.3&plusmn;2.2, <em>p</em>=0.016), left ventricular ejection fraction (46&plusmn;13 vs 43&plusmn;13, <em>p</em>=0.016), heart failure complication (30.3 vs 17.3%, <em>p</em>=0.002), cardiogenic shock complication (15.0 vs 6.6%, <em>p</em>=0.007), atrioventricular block complication (7.9 vs 1.8%, <em>p</em>=0.006), sustained ventricular tachycardia (10.9 vs 4.7%, <em>p</em>=0.022) and cardiac arrest (12.7 vs 2.4%, <em>p</em>&lt;0.001). On the other hand, group B was elderly (70&plusmn;14 vs 75&plusmn;11, p&lt;0.001), was higher time from the first symptoms until medical assistance (p&lt;0.001) and brain natriuretic peptide (720&plusmn;1212 vs 1051&plusmn;1239, p=0.006). Curiously, late AF group had higher rates of amiodarone prescription (22.8 vs 38.3%, <em>p</em>&lt;0.001), and the early group had more frequent beta blocker prescription (73.7 vs 63.4%, <em>p</em>&lt;0.001).&nbsp; </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Late new-onset of AF in STEMI patients was elderly, had higher time since the first symptom until medical assistance and had higher levels of brain natriuretic peptide. On the other hand, early new-onset of AF in STEMI had higher rates of major cardiac adverse events.</span></span></span></span></p>