Comparison of clinical characteristics, treatment, in-hospital and 12-month outcomes in patients after myocardial infarction with ejection fraction < 40% with or without atrial fibrillation
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3rd Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases in Zabrze, Poland
Collegium Medicum, Kardynał Stefan Wyszynski Univeristy in Warsaw, Poland
National Institute of Cardiology in Warsaw, Poland
Department of Cardiology and Structural Heart Diseases, Medical University of Silesia in Katowice, Poland
Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
Clinical Department of Cardiology, Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
Submission date: 2020-05-27
Final revision date: 2020-07-19
Acceptance date: 2020-07-22
Online publication date: 2020-10-26
The study aimed to compare the characteristics, treatment, and 12-month outcomes of patients after myocardial infarction (MI) and with left ventricular ejection fraction (LVEF) < 40%, with or without atrial fibrillation (AF).

Material and methods:
The analysis involved 10,222 surviving patients who were enrolled in the ongoing, prospective Polish Registry of Acute Coronary Syndromes (PL-ACS). The major adverse cardiac events (MACE) involved death, non-fatal MI, rehospitalization due to heart failure (HF), and stroke within 12 months after MI.

Patients with AF were older (73.7 [13.1] vs. 68.3 [16.4], p < 0.001) and had a greater prevalence of previous MI (37.3% vs. 32.4%, p = 0.0007), percutaneous coronary intervention (PCI) (27.5% vs. 23.6%, p = 0.002), and HF hospitalization (34.6% vs. 19.7%, p < 0.001). In patients with AF, coronary angiography (87.3% vs. 92.5%, p < 0.001) and PCI (76.8% vs. 82.7%, p < 0.001) were performed less frequently. Patients with AF had a higher rate of all-cause mortality (26.8% vs. 17.4%, p < 0.001), HF hospitalization (35.0% vs. 25.3%, p < 0.001), stroke (5.5% vs. 2.1%, p < 0.001) and MACE (56.2% vs. 42.8%, p < 0.001). In the multivariate analysis, AF was revealed to be associated with a higher all-cause mortality (odds ratio 1.20, 95% confidence interval 1.03–1.40, p = 0.018).

Patients after MI with LVEF < 40% and with AF, compared to those without AF, had worse clinical characteristics, were less frequently subjected to coronary angiography and PCI during hospitalization, and had significantly less favorable 12-month outcomes.