Hyeon Seok Hwang a , Mahn-Won Park b , Hye Eun Yoon a , Yoon Kyung Chang a , Chul Woo Yang a , Suk Young Kim a , Jung Sun Cho b , Chan Joon Kim b , Gyung-Min Park b , Chul-Soo Park b , Yun-Seok Choi b , Yoon-Seok Koh b , Jong Min Lee b , Dong Il Shin b , Suk Min Seo b , Doo Soo Jeon b , Keon Woong Moon b , Ki Dong Yoo b , Hee Yeol Kim b , Dong-Bin Kim b , Hun-Jun Park b , Pum-Joon Kim b , Kiyuk Chang b , Wook-Sung Chung b , Ki-Bae Seung b , Myung Ho Jeong c , Sung-Ho Her b , Youngkeun Ahn c , *
29 October 2014
Background/Aims: Atrial fibrillation (AF) often coexists with acute myocardial infarction (AMI), and chronic kidney disease (CKD) is a major risk for AMI. However, the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined. Methods: Between January 2004 and December 2009, a total of 4,738 AMI patients were enrolled prospectively. Patients were divided into four groups according to the combined status of CKD and AF. The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events (MACCE). Results: The prevalence of AF was significantly higher in CKD patients than in non-CKD patients (6.76 vs. 3.31%, p < 0.001). The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF (68.5 and 64.0%), respectively. In multivariable analyses, compared with patients with neither AF nor CKD, hazard ratios (HR) for composite of MACCE were 1.66 (95% CI, 1.14-2.41), 1.24 (95% CI, 1.06-1.46), and 2.10 (95% CI, 1.42-3.13) for patients with AF only, those with CKD only, and those with both CKD and AF, respectively (p for interaction = 0.935). Patients with both CKD and AF had a greatest risk for all-cause mortality (HR 2.54; 95% CI, 1.60-4.53), and the significant synergistic interaction was observed between CKD and AF (p for interaction = 0.015). Conclusion: The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition, and it confers a synergistic effect on the all-cause mortality risk.