A place to move your ideas

Un posto dove muovere le tue idee

G. Berton, R. Cordiano, F. Cucchini, F. Cavuto, M. Pellegrinet, P. Palatini

Aims: Atrial fibrillation⁄flutter (AF⁄FL) is a common complication of acute myocar-dial infarction (AMI). Indeed, the determinants of AF⁄FL in AMI-patients and theassociation of AF⁄FL with mortality are not well-known. The purpose of the pres-ent study was to investigate the relationship between presence of AF⁄FL and mor-tality in patients with AMI and to report on predictors of AF⁄FL.

Methods: We studied 505 patients enrolled in three intensive care units with definite AMI andfollowed up for 7 years. No patient was lost to follow-up. Patients with AF⁄FLduring the 1st week of hospitalisation were compared with those with steady sinusrhythm. End-points were all-cause mortality and modes of death.

Results: At multivariable logistic regression analysis, elderly, body mass index, congestive heartfailure (CHF), history of hypertension and plasma cholesterol (in a negative fashion)were independently associated with the presence of AF⁄FL. At survival analysis,after full adjustment, AF⁄FL was not associated with in-hospital mortality. After7 years of follow-up, AF⁄FL was found to be associated with all-cause mortality[adjusted odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.2–2.3], togetherwith age, diabetes mellitus, creatine kinase-MB isoenzyme (CK-MB) peak, CHF,estimated glomerular filtration rate and thrombolysis. At adjusted logistic polyno-mial regression analysis, AF⁄FL was found to be associated with an excess of mor-tality for reasons of sudden death (SD) (adjusted OR = 2.7; 95% CI = 1.2–6.4).No interaction was observed between AF⁄FL and medications on in-hospitalmortality. For 7-year mortality, angiotensin-converting enzyme (ACE)-inhibitors anddigitalis showed an independent negative (protective) interaction chiefly on SD(adjusted OR = 0.06; 95% CI = 0.01–0.74, and RR = 0.10; 95% CI = 0.02–0.58, respectively).

Conclusions: Patients with AMI and AF⁄FL portend a poorprognosis in the long-term chiefly because of an excess of SD. Treatment withACE-inhibitors and digitalis may have long-term beneficial effects on SD.

Welcome

In 1992, a small group of medical researchers and other participants embarked on an project to investigate new clinical factors for heart disease, studying patients with acute coronary syndrome and following them for many years. Today, the observations on the long-term survival after acute coronary syndrome are internationally acknowledged. Main results appears on the most important cardiovascular texts across the world. The study is called “the ABC heart disease study”.

Nel 1992, un piccolo gruppo di medici ricercatori ed altri operatori sanitari, iniziarono un progetto per studiare nuovi fattori clinici della malattia cardiaca, studiando pazienti con sindrome coronarica acuta e seguendoli per molti anni. Oggi, ciò che è stato osservato sulla sopravvivenza a lungo temine dopo sindrome coronarica acuta è riconosciuto a livello internazionale. I principali risultati appaiono sui maggiori testi di medicina cardiovascolare in tutto il mondo. Questo progetto è stato chiamato “the ABC heart disease study”.

Mission

The Mission of the ABC Study on Heart Disease Project is to promote the knowledge on heart disease chiefly based on the long-term follow up of the patients. And to promote citizen health supporting preventive, social, and sport activities.