New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up: A Nationwide Study

Casper N Bang; Gunnar H Gislason; Anders M Greve; Christian A Bang; Alexander Lilja; Christian Torp-Pedersen; Per Kragh Andersen; Lars Køber; Richard B Devereux; Kristian Wachtell

doi:10.1161/JAHA.113.000382

New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up: A Nationwide Study

Casper N Bang, Gunnar H Gislason, Anders M Greve, Christian A Bang, Alexander Lilja, Christian Torp-Pedersen, Per Kragh Andersen, Lars Køber, Richard B Devereux, Kristian Wachtell

42 Citations (Scopus)

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Abstract

New-onset atrial fibrillation (AF) is reported to increase the risk of death in myocardial infarction (MI) patients. However, previous studies have reported conflicting results and no data exist to explain the underlying cause of higher death rates in these patients. All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. The impact of new-onset AF on all-cause mortality, cardiovascular death, fatal/nonfatal stroke, fatal/nonfatal re-infarction and noncardiovascular death, were analyzed by multiple time-dependent Cox models and additionally in propensity score matched analysis. In 89 703 patients with an average follow-up of 5.0 ± 3.5 years event rates were higher in patients developing AF (n=10 708) versus those staying in sinus-rhythm (n=78 992): all-cause mortality 173.9 versus 69.4 per 1000 person-years, cardiovascular death 137.2 versus 50.0 per 1000 person-years, fatal/nonfatal stroke 19.6/19.9 versus 6.2/5.6 per 1000 person-years, fatal/nonfatal re-infarction 29.0/60.7 versus 14.2/37.9 per 1000 person-years. In time-dependent multiple Cox analyses, new-onset AF remained predictive of increased all-cause mortality (HR: 1.9 [95% CI: 1.8 to 2.0]), cardiovascular death (HR: 2.1 [2.0 to 2.2]), fatal/nonfatal stroke (HR: 2.3 [2.1 to 2.6]/HR: 2.5 [2.2 to 2.7]), fatal/nonfatal re-infarction (HR: 1.7 [1.6 to 1.8]/HR: 1.8 [1.7 to 1.9]), and non- cardiovascular death (HR: 1.4 [1.3 to 1.5]) all P<0.001). Propensity-score matched analyses yielded nearly identical results (all P<0.001). New-onset AF after first-time MI is associated with increased mortality, which is largely explained by more cardiovascular deaths. Focus on the prognostic impact of post-infarct AF is warranted.

Original language	English
Article number	e000382
Journal	American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease
Volume	3
Issue number	1
Number of pages	10
ISSN	2047-9980
DOIs	https://doi.org/10.1161/JAHA.113.000382
Publication status	Published - 21 Jan 2014

Keywords

Aged
Aged, 80 and over
Atrial Fibrillation
Cause of Death
Denmark
Female
Follow-Up Studies
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Prognosis
Propensity Score
Proportional Hazards Models
Recurrence
Registries
Retrospective Studies
Risk Factors
Stroke
Time Factors

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Bang, C. N., Gislason, G. H., Greve, A. M., Bang, C. A., Lilja, A., Torp-Pedersen, C., Andersen, P. K., Køber, L., Devereux, R. B., & Wachtell, K. (2014). New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up: A Nationwide Study. American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease, 3(1), [e000382]. https://doi.org/10.1161/JAHA.113.000382

New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up : A Nationwide Study. / Bang, Casper N ; Gislason, Gunnar H; Greve, Anders M et al.

In: American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease, Vol. 3, No. 1, e000382, 21.01.2014.

Research output: Contribution to journal › Journal article › Research › peer-review

Bang, CN , Gislason, GH, Greve, AM, Bang, CA, Lilja, A, Torp-Pedersen, C , Andersen, PK , Køber, L, Devereux, RB & Wachtell, K 2014, 'New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up: A Nationwide Study', American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease, vol. 3, no. 1, e000382. https://doi.org/10.1161/JAHA.113.000382

Bang CN , Gislason GH, Greve AM, Bang CA, Lilja A, Torp-Pedersen C et al. New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up: A Nationwide Study. American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease. 2014 Jan 21;3(1):e000382. doi: 10.1161/JAHA.113.000382

Bang, Casper N ; Gislason, Gunnar H ; Greve, Anders M et al. / New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up : A Nationwide Study. In: American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease. 2014 ; Vol. 3, No. 1.

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title = "New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up: A Nationwide Study",

abstract = "New-onset atrial fibrillation (AF) is reported to increase the risk of death in myocardial infarction (MI) patients. However, previous studies have reported conflicting results and no data exist to explain the underlying cause of higher death rates in these patients. All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. The impact of new-onset AF on all-cause mortality, cardiovascular death, fatal/nonfatal stroke, fatal/nonfatal re-infarction and noncardiovascular death, were analyzed by multiple time-dependent Cox models and additionally in propensity score matched analysis. In 89 703 patients with an average follow-up of 5.0 ± 3.5 years event rates were higher in patients developing AF (n=10 708) versus those staying in sinus-rhythm (n=78 992): all-cause mortality 173.9 versus 69.4 per 1000 person-years, cardiovascular death 137.2 versus 50.0 per 1000 person-years, fatal/nonfatal stroke 19.6/19.9 versus 6.2/5.6 per 1000 person-years, fatal/nonfatal re-infarction 29.0/60.7 versus 14.2/37.9 per 1000 person-years. In time-dependent multiple Cox analyses, new-onset AF remained predictive of increased all-cause mortality (HR: 1.9 [95% CI: 1.8 to 2.0]), cardiovascular death (HR: 2.1 [2.0 to 2.2]), fatal/nonfatal stroke (HR: 2.3 [2.1 to 2.6]/HR: 2.5 [2.2 to 2.7]), fatal/nonfatal re-infarction (HR: 1.7 [1.6 to 1.8]/HR: 1.8 [1.7 to 1.9]), and non- cardiovascular death (HR: 1.4 [1.3 to 1.5]) all P<0.001). Propensity-score matched analyses yielded nearly identical results (all P<0.001). New-onset AF after first-time MI is associated with increased mortality, which is largely explained by more cardiovascular deaths. Focus on the prognostic impact of post-infarct AF is warranted.",

keywords = "Aged, Aged, 80 and over, Atrial Fibrillation, Cause of Death, Denmark, Female, Follow-Up Studies, Humans, Linear Models, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction, Prognosis, Propensity Score, Proportional Hazards Models, Recurrence, Registries, Retrospective Studies, Risk Factors, Stroke, Time Factors",

author = "Bang, {Casper N} and Gislason, {Gunnar H} and Greve, {Anders M} and Bang, {Christian A} and Alexander Lilja and Christian Torp-Pedersen and Andersen, {Per Kragh} and Lars K{\o}ber and Devereux, {Richard B} and Kristian Wachtell",

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T1 - New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up

T2 - A Nationwide Study

AU - Bang, Casper N

AU - Gislason, Gunnar H

AU - Greve, Anders M

AU - Bang, Christian A

AU - Lilja, Alexander

AU - Torp-Pedersen, Christian

AU - Andersen, Per Kragh

AU - Køber, Lars

AU - Devereux, Richard B

AU - Wachtell, Kristian

PY - 2014/1/21

Y1 - 2014/1/21

N2 - New-onset atrial fibrillation (AF) is reported to increase the risk of death in myocardial infarction (MI) patients. However, previous studies have reported conflicting results and no data exist to explain the underlying cause of higher death rates in these patients. All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. The impact of new-onset AF on all-cause mortality, cardiovascular death, fatal/nonfatal stroke, fatal/nonfatal re-infarction and noncardiovascular death, were analyzed by multiple time-dependent Cox models and additionally in propensity score matched analysis. In 89 703 patients with an average follow-up of 5.0 ± 3.5 years event rates were higher in patients developing AF (n=10 708) versus those staying in sinus-rhythm (n=78 992): all-cause mortality 173.9 versus 69.4 per 1000 person-years, cardiovascular death 137.2 versus 50.0 per 1000 person-years, fatal/nonfatal stroke 19.6/19.9 versus 6.2/5.6 per 1000 person-years, fatal/nonfatal re-infarction 29.0/60.7 versus 14.2/37.9 per 1000 person-years. In time-dependent multiple Cox analyses, new-onset AF remained predictive of increased all-cause mortality (HR: 1.9 [95% CI: 1.8 to 2.0]), cardiovascular death (HR: 2.1 [2.0 to 2.2]), fatal/nonfatal stroke (HR: 2.3 [2.1 to 2.6]/HR: 2.5 [2.2 to 2.7]), fatal/nonfatal re-infarction (HR: 1.7 [1.6 to 1.8]/HR: 1.8 [1.7 to 1.9]), and non- cardiovascular death (HR: 1.4 [1.3 to 1.5]) all P<0.001). Propensity-score matched analyses yielded nearly identical results (all P<0.001). New-onset AF after first-time MI is associated with increased mortality, which is largely explained by more cardiovascular deaths. Focus on the prognostic impact of post-infarct AF is warranted.

AB - New-onset atrial fibrillation (AF) is reported to increase the risk of death in myocardial infarction (MI) patients. However, previous studies have reported conflicting results and no data exist to explain the underlying cause of higher death rates in these patients. All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. The impact of new-onset AF on all-cause mortality, cardiovascular death, fatal/nonfatal stroke, fatal/nonfatal re-infarction and noncardiovascular death, were analyzed by multiple time-dependent Cox models and additionally in propensity score matched analysis. In 89 703 patients with an average follow-up of 5.0 ± 3.5 years event rates were higher in patients developing AF (n=10 708) versus those staying in sinus-rhythm (n=78 992): all-cause mortality 173.9 versus 69.4 per 1000 person-years, cardiovascular death 137.2 versus 50.0 per 1000 person-years, fatal/nonfatal stroke 19.6/19.9 versus 6.2/5.6 per 1000 person-years, fatal/nonfatal re-infarction 29.0/60.7 versus 14.2/37.9 per 1000 person-years. In time-dependent multiple Cox analyses, new-onset AF remained predictive of increased all-cause mortality (HR: 1.9 [95% CI: 1.8 to 2.0]), cardiovascular death (HR: 2.1 [2.0 to 2.2]), fatal/nonfatal stroke (HR: 2.3 [2.1 to 2.6]/HR: 2.5 [2.2 to 2.7]), fatal/nonfatal re-infarction (HR: 1.7 [1.6 to 1.8]/HR: 1.8 [1.7 to 1.9]), and non- cardiovascular death (HR: 1.4 [1.3 to 1.5]) all P<0.001). Propensity-score matched analyses yielded nearly identical results (all P<0.001). New-onset AF after first-time MI is associated with increased mortality, which is largely explained by more cardiovascular deaths. Focus on the prognostic impact of post-infarct AF is warranted.

KW - Aged

KW - Aged, 80 and over

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KW - Cause of Death

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KW - Humans

KW - Linear Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Prognosis

KW - Propensity Score

KW - Proportional Hazards Models

KW - Recurrence

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

KW - Stroke

KW - Time Factors

U2 - 10.1161/JAHA.113.000382

DO - 10.1161/JAHA.113.000382

M3 - Journal article

C2 - 24449803

SN - 2047-9980

VL - 3

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

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