Increased risk of both mortality and morbidity with prior as well as current atrial fibrillation after MI: results of VALIANT

Kober, L., Maggioni, A.P., McMurray, J.J. , Velazquez, E.J., Zelenkofske, S., Zannad, F., Van de Werf, F. and Swedberg, K. (2004) Increased risk of both mortality and morbidity with prior as well as current atrial fibrillation after MI: results of VALIANT. Journal of Cardiac Failure, 10(4), S100. (doi: 10.1016/j.cardfail.2004.06.305)

Abstract

Purpose: New-onset atrial fibrillation (AF) after myocardial infarction (MI) is associated with increased short-term mortality. The longer-term relationship between AF and both fatal and non-fatal outcomes is less well defined. Similarly, how the risk related to new-onset AF compares with that of pre-existing AF is unknown. Methods: The VALsartan In Acute myocardial iNfarcTion (VALIANT) trial enrolled 14,703 patients with heart failure (HF), left ventricular systolic dysfunction (LVSD), or both after MI. AF status was assessed at presentation and again at randomization (median 4.9 days after symptom onset). ‘Current AF’ was defined as AF detected at any time from admission to randomization. Patients with a history of AF on admission but without ‘Current AF’ were defined as ‘Prior AF.’ The main outcomes were death and cardiovascular (CV) mortality/morbidity (CV death, MI, HF, stroke, or resuscitated sudden death) during a 3-year follow-up. The hazard ratio (HR) of AF was obtained from multivariable models including <70 covariates. Results: A total of 339 (2%) patients had prior AF, 1812 (12%) had current AF, and 12,509 (86%) patients had no AF. AF status was unknown in 43 patients. Current and Prior AF patients were older and more often women. They had more previous HF, angina, and MI but were less likely to receive a beta-blocker or thrombolytic treatment than those without AF. Patients with AF were more often in Killip class II or above than were patients without AF. Three-year mortality was 17% in patients without AF compared with 31% in current AF patients and 32% in prior AF patients. In a Cox regression multivariable model, compared with no AF, prior AF was associated with increased mortality (HR 1.25, 95% CI 1.03–1.52; P = 0.03), as was current AF (HR 1.32, 1.20–1.45; P<0.0001). The adjusted HR for CV mortality/morbidity with prior AF was 1.15 (0.98–1.35; P = 0.08) and 1.21 (1.12–1.31; P<0.0001) for current AF. Conclusions: Current and prior AF were associated with a higher long-term mortality and greater risk of adverse CV events after an MI complicated by HF and/or LVSD. Whether the risk associated with AF can be reversed with treatment is an important clinical question, as this arrhythmia occurs in a high proportion of these patients.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Kober, L., Maggioni, A.P., McMurray, J.J., Velazquez, E.J., Zelenkofske, S., Zannad, F., Van de Werf, F., and Swedberg, K.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Cardiac Failure
• Publisher: Elsevier
• ISSN: 1071-9164
• ISSN (Online): 1532-8414
• Published Online: 19 August 2004