Introduction _______________________________________

1. Prognostic significance of atrial fibrillation/flutter following acute myocardial infarction in patients with diabetes mellitusM.Gashi,E.Pllana,D.Kocinaj,S.Rexhepi University Clinical Center of Kosovo, Prishtine

2. Introduction_______________________________________ • Any type of infarct can lead to an abnormal conduction interface which may lead to re-entry rhythm mechanism, and • any infarct can lead to impaired LV filling, leading to acute atrial enlargement causing atrial arrhythmias including AF. __________________________________________ Sakata K,Kurihara H,Iwamori K et al. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction Am.J Cardiol. 1997; 80: 1522-1527. Pizzeti F, Turrazza FM, Franzosi MG et al. on behalf of the GISSI-3 investigators.Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction:the GISSI-3 data Heart 2001; 86:527-532.

3. Introduction_______________________________________ • AF is observed in up to 20% of AMI patients complicating AMI. • AF seen during AMI is reported to be associated with longer hospitalization, higher in-hospital and long term mortality, and • An increased incidence of stroke compared with the patient without AF ________________________________________ Rather Soberer AK,Weinfurt KP et al.Acute myocardial Infarction complicated by atrial fibrillation in the elderly.Prevalence and outcames.Circulation 2000;101: 969-974

4. Introduction_______________________________________ • Despite its frequent occurrence the prognostic significance of AF complicating AMI remains controversial. • Although some studies have identified increased in-hospital and long term mortality associated with AF, • Others have found no independent effect. ______________________________ Sakata K,Kurihara H,Iwamori K et al. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction Am.J Cardiol. 1997; 80: 1522-1527.

5. Materials and Methods_______________________________________ • We evaluated 2667 pts treated for acute myocardial infarction from 2003-2008 in our CCU • We limited our analysis to patients presenting with the confirmed AMI (2 of the following 3 criteria): - chest pain during the prior 48 hours - two fold elevation in CK (elevation CK-MB level > 6% - diagnostic ECG changes

6. Study end points_______________________________________ • The aims of our study were to assess the occurrence of AF/F in a population of patients during AMI with diabetes mellitus during hospitalization, and • To determine the prognostic impact of AF on in hospital mortality compared to the patients with sinus rhythm.

7. Materials and Methods_______________________________________ • The diagnosis of onset AF was based on a patient's follow-up ECG at the time of hospitalization and last recording before the patient was discharged from the clinic or died. • During the hospitalization all patients were examined by cardiologist.

8. Materials and Methods_______________________________________ The following information was recorded: - medical history - physical examination - Killip classification - ECG - echocardiography - resting blood pressure - heart rate and - blood samples Since this was part of routine clinical practice in the CCU, patients were not asked to provide written consent for collecting off clinical data

9. Results_______________________________________ • During the inclusion period a total of 2667 pts with AMI were analyzed. • Of these, 386 pts (14.5%) suffered from AF/F. • From 386 pts with AF/F 117 pts (31.5%) were with diabetes mellitus.

10. Results_______________________________________

11. Table 1. Baseline characteristics of the 2667 patients with AMI_______________________________________________________________ SR group AF/F group p< 2281 (85.5%) 386 (14.5%) value

12. Results____________________________ • In patients with diabetes mellitus and low LVEF presence of AF/F was associated with significant increase in hospital mortality ( HR 1.45; CI 1.05-2.06; p=0.02) compared to the patients with SR. • Sustained AF during hospitalization was associated with the risk of dying, relative risk=1.6 (95% CI 1.4-1.9).

13. Discussion_______________________________ • The main result of this study is that the occurrence of AF during AMI in patients with diabetes mellitus is associated with increased mortality. • The increased mortality appeared to be higher in patients with severe LV systolic dysfunction.

14. Discussion_______________________________ The limitations of this study are: • All the AF patients were pooled together as a single category without classification and pooling AF and atrial flutter together. • There are no data of AF suppressed with ACE, and with class III anti-arrhythmic drugs in post AMI during hospitalization

15. Conclusion_______________________________ • AF and atrial flutter often occurs during AMI in patients with diabetes mellitus, and • Our analyses demonstrated that AF and atrial flutter were an independent predictor of an increased in hospital mortality.

16. Thank you