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.