P1494The prognostic significance of atrial fibrillation in patients with ST-elevation myocardial infarction: a sub-study of the randomized TOTAL trial

Abstract

Background/Introduction: Atrial fibrillation (AF) often accompanies ST‐elevation myocardial infarction (STEMI). The long‐term prognostic value of AF in STEMI is somewhat controversial. Purpose: The aim of the present study was to determine the long‐term prognostic significance of AF in the pre‐PCI ECG in STEMI patients undergoing primary PCI. Methods: We analyzed 1‐year follow up data of 8,830 patients from the randomized Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) trial. Patients with AF were compared with patients with sinus rhythm. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock or new or worsening New York Heart Association (NYHA) class IV heart failure. Results: Of the patients, 437 (4.9%) had AF on admission. Patients with AF were older and had more often a medical history of stroke, hypertension and myocardial infarction. The rate of primary outcome and cardiovascular death was higher in the AF group than in the sinus rhythm group (17.4% vs. 7.4%; HR 2.51; 95% Cl 1.97‐3.19, p<0.001 and 9.8% vs. 3.3%; HR 3.12; 95% Cl 2.26‐4.31, p<0.001, respectively). Patients with AF also had a higher rate of all‐cause mortality (11.4% vs. 3.9%; HR 3.06; 95% CI 2.27‐4.12, p<0.001), major bleeding (3.2% vs. 1.8%; HR 1.81; 95% CI 1.05‐3.13, p=0.033) and stroke (2.7% vs. 0.9%; HR 3.21; 95% Cl 1.75‐5.91, p<0.001). AF was independently predictive of adverse outcome in multivariable analysis (HR 1.89; 95% CI 1.48‐2.42, p<0.001). Conclusion: AF in the ECG recorded in the acute phase of STEMI before primary PCI is an independent risk factor for worse long‐term outcome. STEMI patients with AF have a higher risk of all‐cause and cardiovascular death, severe heart failure and stroke at one‐year follow‐up. (Figure Presented).