To characterize and estimate the incidence rate of new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (MI). To explore the prognostic influences of NOAF on MI patients' clinical outcomes. To further investigate the impact of NOAF associated characteristics on patients' clinical outcomes eithier during hospitalization or follow-up period.
In the present study, investigators retrospectively reviewed the medical records of all acute MI patients who were admitted to the coronary artery unit (CCU) of Shanghai Tenth People's Hospital between February 2014 and March 2018. All eligible patients' demographics, cardiovascular risk factors, comorbidities, laboratory tests, echocardiography data, angiography data, acute and dischage medications, and clinical outcomes will be collected. All patients admitt to our CCU department will receive CEM immediately after admission and continue until discharge. Heart thythm status and those characteristics assoicated with NOAF will be reviewed by several independent physicians and recorded in a centralized electronic database. Several post-MI NOAF assoicated characteristics and definitions are displayed as follows: 1. Total CEM duration is defined as the period during which the monitor was started after admission and turned off before discharge. 2. AF maintained duration is defined as the period during which an AF episode presented and terminated. 3. Total AF duration is calculated by summing all AF episodes' maintained durations descripted above. 4. AF burden was calculated by dividing the total AF duration by the total CEM duration. 5. NOAF pattern included paroxysmal NOAF, persistent NOAF, transient NOAF, and persisting NOAF, definitions are demonstrated as follows: 1\) Paroxysmal NOAF is defined as more than 1 episodes of AF occur during hospitalization irrespective of the discharge rhythm status or only 1 episode of AF is observed during hospitalization and maintain sinus rhythm at discharge. 2\) Persistent NOAF is defined as only 1 episode of AF is observed during hospitalization and maintain AF at discharge. 3\) Transient NOAF is recorded if AF episodes only occur during hospitalization with emergency department ECG, on-admission ECG and discharge ECG maintaining sinus rhythm, irrespective of the frequencies of AF. 4\) Persisting NOAF is recorded if AF episodes occur during hospitalization with a discharge ECG still maintaining AF rhythm, irrespective of the frequencies of AF. 6\. Frequencies of NOAF 7\. Symptomatic and silent NOAF 1. Symptomatic AF is defined as AFresulting in clinical symptoms or the need for urgent cardioversion. 2. Silent AF is defined as any asymptomatic episodes of AF lasting for over 30 seconds at CEM.
Study Type
OBSERVATIONAL
Enrollment
2,399
All patients with MI hospitalized in the CCU department of Shanghai Tenth People's Hospital will receive 24-hour cardiac monitoring until discharge.
Department of Cardiology, Shanghai Tenth People's Hospital
Shanghai, Shanghai Municipality, China
Major adverse cardiac event (MACE)
Cardiovascular death, recurrent myocardial infarction, rehospitalization for heart failure or stroke
Time frame: From the time of admission to coronary care unit until occurrence of an outcome of interest, death, loss to follow up or April 10, 2019, maximum up to 5 years
All-cause death
Death from any cause
Time frame: From the time of admission to coronary care unit until occurrence of an outcome of interest, death, loss to follow up or April 10, 2019, maximum up to 5 years
Cardiovascular death
Death from cardiovascular causes
Time frame: From the time of admission to coronary care unit until occurrence of an outcome of interest, death, loss to follow up or April 10, 2019, maximum up to 5 years
Recurrent myocardial infarction
Rehospitalization for myocardial infarction
Time frame: From the time of admission to coronary care unit until occurrence of an outcome of interest, death, loss to follow up or April 10, 2019, maximum up to 5 years
Rehospitalization for heart failure
Rehospitalization for heart failure
Time frame: From the time of admission to coronary care unit until occurrence of an outcome of interest, death, loss to follow up or April 10, 2019, maximum up to 5 years
Stroke
Stroke is defined as the presence of a new focal neurologic deficit thought to be vascular in origin, with signs or symptoms lasting\>24h.
Time frame: From the time of admission to coronary care unit until occurrence of an outcome of interest, death, loss to follow up or April 10, 2019, maximum up to 5 years
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In-hospital MACE
Cardiovascular death, nonfatal re-infarction, new congestive heart failure or ischemic stroke at 30 days
Time frame: 30 days
In-hospital sustained ventricular tachycardia/ventricular fibrillation
Sustianed ventricular tachycardia is defined as ventricular arrhythemia lasting for over 30s where emergent cardioversion is required. Ventricular fibrillation is defined as the heart quivers instead of pumping due to disorganized electrical activity in the ventricles.
Time frame: From the time of admission to coronary care unit until discharge
In-hospital cardiogenic shock
Cardiogenic shock is defined as systolic blood pressure \< 90 mmHg not responsive to fluid resuscitation where IV intropes are required.
Time frame: From the time of admission to coronary care unit until discharge
Nonfatal re-infarction at 30 days
Re-infarction is defined as recurrent ischemic symptoms\> 20 min with new ST elevation\> 0.1mV in≥ 2 contiguous leads and was verified by an urgent angiography.
Time frame: 30 days
Ischemic stroke at 30 days
Ischemic stroke is defined as the presence of a new focal neurologic deficit thought to be ischemic in origin, with signs or symptoms lasting over 24 hours, which is validated based on a computerized tomography (CT) or magnetic resonance imaging (MRI) examination.
Time frame: 30 days
New congestive heart failure at 30 days
New congestive heart failure is defined as the first episode of cardiac decompensation requiring intravenous diuretics when patients suffer chest distress, polypnea or dyspnea.
Time frame: 30 days