1. Prognostic significance of atrial fibrillation/flutter following acute myocardial infarction in patients with diabetes mellitus M.Gashi,E.Pllana,D.Kocinaj,S.Rexhepi University Clinical Center of Kosovo, Prishtine

2. Introduction _______________________________________
Any type of infarct can lead to an abnormal conduction interface which may lead to re-entry rhythm mechanism,
and
any infarct can lead to impaired LV filling, leading to acute atrial enlargement causing atrial arrhythmias including AF.
__________________________________________
Sakata K,Kurihara H,Iwamori K et al. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction Am.J Cardiol. 1997; 80:
Pizzeti F, Turrazza FM, Franzosi MG et al. on behalf of the GISSI-3 investigators.Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction:the GISSI-3 data Heart 2001; 86:

3. Introduction _______________________________________
AF is observed in up to 20% of AMI patients complicating AMI.
AF seen during AMI is reported to be associated with longer hospitalization, higher in-hospital and long term mortality, and
An increased incidence of stroke compared with the patient without AF
________________________________________
Rather Soberer AK,Weinfurt KP et al.Acute myocardial Infarction complicated by atrial fibrillation in the elderly.Prevalence and outcames.Circulation 2000;101:

4. Introduction _______________________________________
Despite its frequent occurrence the prognostic significance of AF complicating AMI remains controversial.
Although some studies have identified increased in-hospital and long term mortality associated with AF,
Others have found no independent effect.
______________________________
Sakata K,Kurihara H,Iwamori K et al. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction Am.J Cardiol. 1997; 80:

5. Materials and Methods _______________________________________
We evaluated 2667 pts treated for acute myocardial infarction from in our CCU
We limited our analysis to patients presenting with the confirmed AMI (2 of the following 3 criteria):
- chest pain during the prior 48 hours
- two fold elevation in CK (elevation CK-MB level > 6%
- diagnostic ECG changes

6. Study end points _______________________________________
The aims of our study were to assess the occurrence of AF/F in a population of patients during AMI with diabetes mellitus during hospitalization, and
To determine the prognostic impact of AF on in hospital mortality compared to the patients with sinus rhythm.

7. Materials and Methods _______________________________________
The diagnosis of onset AF was based on a patient's follow-up ECG at the time of hospitalization and last recording before the patient was discharged from the clinic or died.
During the hospitalization all patients were examined by cardiologist.

8. Materials and Methods _______________________________________
The following information was recorded:
- medical history
- physical examination
- Killip classification
- ECG
- echocardiography
- resting blood pressure
- heart rate and
- blood samples
Since this was part of routine clinical practice in the CCU, patients were not asked to provide written consent for collecting off clinical data

9. Results _______________________________________
During the inclusion period a total of 2667 pts with AMI were analyzed.
Of these, 386 pts (14.5%) suffered from AF/F.
From 386 pts with AF/F 117 pts (31.5%) were with diabetes mellitus.

10. Results _______________________________________

11. History of hypertension (%) 26.4 32.5 0.07 Diabetes mellitus (%) 19.7
Table 1. Baseline characteristics of the 2667 patients with AMI _______________________________________________________________ SR group AF/F group p< (85.5%) (14.5%) value
Age (years)
61.2 ± 15.2
67.9 ± 16.7
<0.001
Gender (% male)
50.4
49.3 ns
LVEF(%)
45.4 ± 6.2
37.2 ± 5.5
< 0.001
Heart rate (bpm)
72.3 ± 11.6
82.6 ± 12.2
Systolic BP (mmHg)
137.5 ± 15.7
128.3 ± 11.9
Diastolic BP (mmHg)
77.5 ± 9.6
73.4 ± 9.2
History of stroke (%)
1.2
1.8
History of hypertension (%)
26.4
32.5
0.07
Diabetes mellitus (%)
19.7
31.5
History of MI (%)
34.3
53.8

12. Results ____________________________
In patients with diabetes mellitus and low LVEF presence of AF/F was associated with significant increase in hospital mortality ( HR 1.45; CI ; p=0.02) compared to the patients with SR.
Sustained AF during hospitalization was associated with the risk of dying, relative risk=1.6 (95% CI ).

13. Discussion _______________________________
The main result of this study is that the occurrence of AF during AMI in patients with diabetes mellitus is associated with increased mortality.
The increased mortality appeared to be higher in patients with severe LV systolic dysfunction.

14. Discussion _______________________________
The limitations of this study are:
All the AF patients were pooled together as a single category without classification and pooling AF and atrial flutter together.
There are no data of AF suppressed with ACE, and with class III anti-arrhythmic drugs in post AMI during hospitalization

15. Conclusion _______________________________
AF and atrial flutter often occurs during AMI in patients with diabetes mellitus, and
Our analyses demonstrated that AF and atrial flutter were an independent predictor of an increased in hospital mortality.

16. Thank you