The Association of Atrial Fibrillation before Percutaneous Coronary Intervention with 1-Year Outcome in ST-elevation Myocardial Infarction patients: The Outcome of STEMI patients with Pre-PCI AF

Background: We aimed to determine the association of atrial fibrillation (AF) with 1-year outcome in STEMI patients undergoing primary PCI.

Methods: Patients (n=8,830) enrolled in the Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) were followed for one year. The primary outcome was a composite of cardiovascular death, recurrent MI, cardiogenic shock or new or worsening class IV heart failure. The presence or absence of AF was determined from a single pre-PCI ECG.

Results: Patients with AF (n=437, 4.9%) were older, and more often had a history of stroke, hypertension or MI. The rate of the primary outcome was higher in the AF group than in the sinus rhythm (SR) group (17.4% vs. 7.4%, p<0.001), as was the rate of cardiovascular death (9.8% vs. 3.3%, p<0.001). In multivariable analysis, AF was independently predictive of the primary outcome (aHR 1.68; CI 95%, 1.30-2.16, p<0.001), cardiovascular death (aHR 1.69; CI 95%, 1.19-2.40, p=0.003), all-cause mortality (aHR 1.63; CI 95%, 1.18-2.24, p=0.003) and severe heart failure (aHR 1.96; CI 95%, 1.25-3.07, p=0.003). Among patients in SR, the primary outcome occurred in 307/4,252 (7.2%) in the thrombectomy group and 310/4,141 (7.5%) in the PCI alone group, while among those with AF, these rates were respectively 42/218 (19.3%) and 34/219 (15.5%) (pinteraction=0.26).

Conclusions: In STEMI patients, AF on the pre-PCI ECG is associated with a higher risk of the primary composite cardiovascular outcome, all-cause and cardiovascular death and severe heart failure during one-year follow-up than in patients with SR.