Clinical question: What is the prognostic influence of atrial fibrillation in patients with acute myocardial infarction?
Background: There have been conflicting reports regarding the prognostic impact of atrial fibrillation (AF) in patients with acute myocardial infarction (MI). This study represents the first meta-analysis performed to quantify the mortality risk associated with AF in MI patients.
Study design: Meta-analysis of observational studies.
Setting: Forty-three studies involving 278,854 patients diagnosed with MI from 1972 to 2000.
Synopsis: The odds ratio (OR) of mortality associated with AF in MI patients was 1.46 (95% confidence interval, 1.35 to 1.58, I2=76%, 23 studies). Although there was significant heterogeneity in included studies, in subgroup analysis, the significant association between AF and mortality was present whether the AF was new (defined as occurring for the first time within one week of MI) with OR of 1.37 (95% confidence interval, 1.26 to 1.49; I2=28%, nine studies) or old (defined as pre-existing before the MI admission) with OR of 1.28 (95% confidence interval, 1.16 to 1.40, I2=24%, four studies). Sensitivity analyses performed by pooling studies according to follow-up duration and adjustment for confounding clinical factors had little effect on the estimates.
Bottom line: AF was associated with increased mortality in patients with MI regardless of the timing of AF development.
Citation: Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction. Circulation. 2011;123:1587-1593.
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