New-Onset Atrial Fibrillation after Acute Myocardial Infarction and its Relationship to Admission Biomarkers From the TRIUMPH Registry

摘要

Atrial fibrillation (AF) is an independent predictor of mortality after acute myocardial infarction (AMI). We analyzed the relationship between biomarkers linked to myocardial stretch [NT-pro-brain natriuretic peptide (NT-proBNP)], myocardial damage [Troponin-T (TnT)] and inflammation [high-sensitivity C-reactive protein (hsCRP)] and new-onset AF during AMI to identify patients at high risk for AF. In a prospective multicenter registry of AMI patients from (TRIUMPH), we measured NT-proBNP, TnT, and hsCRP in patients without a history of AF (N=2370). New-onset AF was defined as AF that occurred during the index hospitalization. Hierarchical multivariable logistic regression models were used to determine the association of biomarkers with new-onset AF, after adjusting for other covariates. New-onset AF was documented in 114 AMI patients (4.8%; mean age 58 years; 32% women). For each 2-fold increase in NT-proBNP, there was an 18% increase in the rate of AF (OR 1.18 95% CI 1.03-1.35; p<0.02). Similarly, for every 2-fold increase in hs-CRP, there was a 15% increase in the rate of AF (OR 1.15 95% CI 1.02-1.30; p=0.02). TnT was not independently associated with new-onset AF (OR 0.96 95% CI 0.85-1.07; p=0.3). NT-proBNP and hs-CRP were independently associated with new in-hospital AF after MI, in both men and women, irrespective of race. Our study suggests that markers of myocardial stretch and inflammation, but not the amount of myocardial necrosis, are important determinants of AF in the setting of AMI.