New-onset atrial fibrillation and prognosis in nonagenarians after acute myocardial infarction

Abstract

Background The influence of new-onset atrial fibrillation (AF) on the long-term prognosis of nonagenarians who survive acute myocardial infarction (AMI) has not been demonstrated. Objective Our aim was to study the association between new-onset AF and long-term prognosis of nonagenarians who survive AMI. Methods From a total of 96 patients aged ≥89 years admitted during a 5-year period, 64 (67%) were discharged alive and are the focus of this study. Results Mean age was 91.0±2.0 years, and 39 patients (61%) were women. During admission, 9 patients (14%) presented new-onset AF, 51 (80%) did not present AF, and 4 (6%) had chronic AF. During follow-up (mean 2.3± 2.6 years; 6.6±3.6 years in survivors), 58 patients (91%) died, including the 9 patients with new-onset AF. Cumulative survival at 6, 12, 18, 24, and 30 months was 68.3%, 57.2%, 49.2%, 47.6%, and 31.8%, respectively. The only two independent predictors of mortality in the multivariate analysis were age (hazard ratio [HR] 1.14; 95% confidence interval [CI] 1.01-1.28; p=0.04) and new-onset AF (HR 2.3; 95% CI 1.1-4.8; p=0.02). Conclusion New-onset AF is a marker of poor prognosis in nonagenarians who survive AMI. © The Author(s) 2013.