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Background <p>Atrial fibrillation (AF) is a common arrhythmic complication in individuals presenting with acute myocardial infarction (AMI); however, the distinct clinical features of AF when it manifests at different stages—either early or late during hospitalization—remain insufficiently characterized.</p> Objective <p>This study aimed to investigate the clinical characteristics, 2-year outcomes, and predictive determinants of early versus late newly diagnosed atrial fibrillation (NDAF) in patients with AMI undergoing percutaneous coronary intervention (PCI).</p> Methods <p>A total of 2,345 consecutive AMI patients treated with PCI were retrospectively reviewed and stratified into three categories: early NDAF, late NDAF, and no NDAF. Comparative analyses were performed across these groups, including assessments of baseline clinical profiles, angiographic and echocardiographic findings, and 2-year clinical outcomes.</p> Results <p> <?tk 2?>Among the cohort, 195 patients (8.3%) developed NDAF during hospitalization, with early NDAF observed in 3.8% and late NDAF in 4.5%. Over the 2-year follow-up, patients with either early or late NDAF demonstrated significantly higher rates of hospitalization for heart failure and major bleeding compared to those without NDAF (<i>P</i> &lt; 0.001). Multivariable logistic regression identified ischemic occlusion of atrial branches (<i>P</i> &lt; 0.001) and left atrial enlargement (<i>P</i> = 0.015) as independent predictors of early NDAF. For late NDAF, ischemic occlusion of atrial branches (<i>P</i> = 0.025) and reduced left ventricular ejection fraction (LVEF ≤ 40%, <i>P</i> = 0.007) were significant predictors. Hospitalization due to heart failure was independently associated with LVEF ≤ 40% (<i>P</i> = 0.016), early NDAF (<i>P</i> = 0.039), and late NDAF (<i>P</i> &lt; 0.001).</p> Conclusions <p> <?tk 2?>Both early and late NDAF were linked to increased risks of heart failure–related hospitalization and major bleeding compared to patients who remained in sinus rhythm. Importantly, ischemic occlusion of atrial branches emerged as a shared and independent predictor for both early and late NDAF following AMI.</p>

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Prognostic impact of early and late newly diagnosed atrial fibrillation in acute myocardial infarction treated with percutaneous coronary intervention

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月31日

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  • Xi Wu,
  • Mingxing Wu,
  • Haobo Huang,
  • Zhe Liu,
  • He Huang,
  • Lei Wang

摘要

Background

Atrial fibrillation (AF) is a common arrhythmic complication in individuals presenting with acute myocardial infarction (AMI); however, the distinct clinical features of AF when it manifests at different stages—either early or late during hospitalization—remain insufficiently characterized.

Objective

This study aimed to investigate the clinical characteristics, 2-year outcomes, and predictive determinants of early versus late newly diagnosed atrial fibrillation (NDAF) in patients with AMI undergoing percutaneous coronary intervention (PCI).

Methods

A total of 2,345 consecutive AMI patients treated with PCI were retrospectively reviewed and stratified into three categories: early NDAF, late NDAF, and no NDAF. Comparative analyses were performed across these groups, including assessments of baseline clinical profiles, angiographic and echocardiographic findings, and 2-year clinical outcomes.

Results

Among the cohort, 195 patients (8.3%) developed NDAF during hospitalization, with early NDAF observed in 3.8% and late NDAF in 4.5%. Over the 2-year follow-up, patients with either early or late NDAF demonstrated significantly higher rates of hospitalization for heart failure and major bleeding compared to those without NDAF (P < 0.001). Multivariable logistic regression identified ischemic occlusion of atrial branches (P < 0.001) and left atrial enlargement (P = 0.015) as independent predictors of early NDAF. For late NDAF, ischemic occlusion of atrial branches (P = 0.025) and reduced left ventricular ejection fraction (LVEF ≤ 40%, P = 0.007) were significant predictors. Hospitalization due to heart failure was independently associated with LVEF ≤ 40% (P = 0.016), early NDAF (P = 0.039), and late NDAF (P < 0.001).

Conclusions

Both early and late NDAF were linked to increased risks of heart failure–related hospitalization and major bleeding compared to patients who remained in sinus rhythm. Importantly, ischemic occlusion of atrial branches emerged as a shared and independent predictor for both early and late NDAF following AMI.