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Previously known and newly diagnosed atrial fibrillation: A major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction ☆
Author(s) -
Køber Lars,
Swedberg Karl,
McMurray John J.V.,
Pfeffer Marc A.,
Velazquez Eric J.,
Diaz Rafael,
Maggioni Aldo P.,
Mareev Viatcheslav,
Opolski Grzegorz,
Van de Werf Frans,
Zannad Faiez,
Ertl Georg,
Solomon Scott D.,
Zelenkofske Steven,
Rouleau JeanLucien,
Leimberger Jeffrey D.,
Califf Robert M.
Publication year - 2006
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2005.11.007
Subject(s) - medicine , cardiology , heart failure , atrial fibrillation , myocardial infarction , angina , randomization , randomized controlled trial
Aims To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). Methods The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and/or LVSD. AF was assessed at presentation and at randomization (median 4.9 days after symptom onset). Primary outcomes were risk of death and major CV events 3 years following acute MI. Results A total of 1812 with current AF (AF between presentation and randomization), 339 patients with prior AF (history of AF without current AF), and 12,509 without AF were enrolled. Patients with AF were older; had more prior HF, angina, and MI, and received beta‐blockers and thrombolytics less often than those without AF. Three‐year mortality estimates were 20% in those without AF, 37% with current AF, and 38% with prior AF. Compared with patients without AF, the multivariable adjusted HR of death was 1.25 (1.03–1.52; p = 0.03) for prior AF and 1.32 (1.20–1.45; p < 0.0001) for current AF. HR for major CV events was 1.15 (0.98–1.35; p = 0.08) and 1.21 (1.12–1.31; p < 0.0001). Conclusion AF is associated with greater long‐term mortality and adverse CV events with acute MI complicated by HF or LVSD.