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      Impact of Glomerular Filtration Rate on the Incidence and Prognosis of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

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          Abstract

          Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated. Methods: We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 ( n = 1887): GFR >60; group 2 ( n = 492): GFR 60–30; group 3 ( n = 66): GFR <30 mL/min/1.73 m 2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints. Results: The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively ( p < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; p < 0.0001) and long-term (34% vs. 13%; p < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; p < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; p < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission.

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          Most cited references 29

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          A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation

           Andrew Levey (1999)
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            2018 ESC/EACTS Guidelines on myocardial revascularization

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              Stroke and bleeding in atrial fibrillation with chronic kidney disease.

              Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions. Using Danish national registries, we identified all patients discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation between 1997 and 2008. The risk of stroke or systemic thromboembolism and bleeding associated with non-end-stage chronic kidney disease and with end-stage chronic kidney disease (i.e., disease requiring renal-replacement therapy) was estimated with the use of time-dependent Cox regression analyses. In addition, the effects of treatment with warfarin, aspirin, or both in patients with chronic kidney disease were compared with the effects in patients with no renal disease. Of 132,372 patients included in the analysis, 3587 (2.7%) had non-end-stage chronic kidney disease and 901 (0.7%) required renal-replacement therapy at the time of inclusion. As compared with patients who did not have renal disease, patients with non-end-stage chronic kidney disease had an increased risk of stroke or systemic thromboembolism (hazard ratio, 1.49; 95% confidence interval [CI], 1.38 to 1.59; P<0.001), as did those requiring renal-replacement therapy (hazard ratio, 1.83; 95% CI, 1.57 to 2.14; P<0.001); this risk was significantly decreased for both groups of patients with warfarin but not with aspirin. The risk of bleeding was also increased among patients who had non-end-stage chronic kidney disease or required renal-replacement therapy and was further increased with warfarin, aspirin, or both. Chronic kidney disease was associated with an increased risk of stroke or systemic thromboembolism and bleeding among patients with atrial fibrillation. Warfarin treatment was associated with a decreased risk of stroke or systemic thromboembolism among patients with chronic kidney disease, whereas warfarin and aspirin were associated with an increased risk of bleeding. (Funded by the Lundbeck Foundation.).
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                09 May 2020
                May 2020
                : 9
                : 5
                Affiliations
                [1 ]Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy; nicola.cosentino@ 123456ccfm.it (N.C.); m.ballarotto@ 123456gmail.com (M.B.); jeness.campodonico@ 123456ccfm.it (J.C.); valentina.milazzo@ 123456ccfm.it (V.M.); alice.bonomi@ 123456ccfm.it (A.B.); marco.moltrasio@ 123456ccfm.it (M.M.); monica.demetrio@ 123456ccfm.it (M.D.M.); mara.rubino@ 123456ccfm.it (M.R.); fabrizio.veglia@ 123456ccfm.it (F.V.); emilio.assanelli@ 123456ccfm.it (E.A.); ivana.marana@ 123456ccfm.it (I.M.); marco.grazi@ 123456ccfm.it (M.G.); gianfranco.lauri@ 123456ccfm.it (G.L.); antonio.bartorelli@ 123456ccfm.it (A.L.B.)
                [2 ]Nephrology Unit, San Gerardo Hospital, University of Milan-Bicocca, 20100 Milan, Italy; simonetta.genovesi@ 123456unimib.it
                [3 ]Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20157 Milan, Italy
                Author notes
                [* ]Correspondence: giancarlo.marenzi@ 123456ccfm.it ; Tel.: +39-02-5800-21
                Article
                jcm-09-01396
                10.3390/jcm9051396
                7291027
                32397347
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

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