Predictors of atrial fibrillation in patients with ST-segment elevation myocardial infarction

Objective. To determine the predictors of atrial fibrillation (AF) development in patients with ST-segment elevation myocardial infarction (STEMI). Materials and methods. The study presents the results of the first (in-hospital) stage of a prospective, two-stage, open-label, observational clinical trial with a retrospective assessment of the patient data prior to their enrollment in the study. Over a 2-year period, 167 patients with STEMI were sequentially included into the study on admission to a multidisciplinary hospital according to the inclusion and exclusion criteria. To determine the predictors of AF development in STEMI patients, they were divided into 2 groups: Group 1 comprised 140 patients (83.8 %) with STEMI and no AF during hospitalization or in their medical history; Group 2 included 27 patients (16.2 %) with STEMI who experienced an AF paroxysm during hospitalization. Results. The prevalence of AF among 167 hospitalized patients with STEMI was 16.2 % (n=27). In 9.6 % of cases, AF paroxysm was verified for the first time, while in 6.8 % it was a manifestation of a pre-existing paroxysmal form. Systolic blood pressure BP 90 mmHg, heart rate 50 bpm and 110 bpm, and Killip class 1 increased the relative risk (RR) of AF paroxysm in MI patients by 2.3-fold, 6.1-fold, and 3.0-fold, respectively. Comorbid conditions such as obesity, chronic heart failure, and a history of pulmonary pathology increased the RR of AF by 2.6-fold, 2.3-fold, and 2.2-fold, respectively. Pre-admission use of renin-angiotensin-aldosterone system (RAAS) blockers and beta-blockers reduced the RR of AF development by 71 %, whereas the need for insulin therapy increased by 3.1-fold. In addition to the well-known predictors of AF development in MI associated with cardiac and renal remodeling, new ones were identified: left atrial contractile dysfunction index 40 %; left ventricular ejection fraction (LVEF)-to-indexed left atrial volume ratio 1.1; cystatin-based glomerular filtration rate 45 ml/min/1.73 m2; urinary albumin-to-creatinine ratio 300 mg/g; and creatinine-to-LVEF ratio. These increased the RR by 7.1-fold, 6.7-fold, 2.7-fold, 3.1-fold, and 2.7-fold, respectively. Among the new biomarkers associated with AF development in MI, the following were identified: blood apolipoprotein B100 (ApoB100) concentration 100 mg/dL; monocytes-to-high-density lipoprotein cholesterol ratio 26.5; tissue inhibitor of matrix metalloproteinase type 1 (TIMP-1) 124.2 ng/ml; platelet-to-lymphocyte ratio 212.1; inflammatory burden index 36.85; the combination of the GG genotype of the ApoB gene polymorphism Arg3500Gln (rs5742904) with the ID genotype of the fibrinogen alpha (FGA) gene polymorphism rs35496957. These increased the RR by 3.5-fold, 2.8-fold, 5.6-fold, 2.5-fold, 3.3-fold, and 3.6-fold, respectively. Conclusions. The study confirmed the clinical and historical predictors of AF paroxysm development in patients with STEMI and identified novel predictors associated with coupled structural and functional remodeling of the left and right ventricles, in combination with renal dysfunction, lipid metabolism disorders involving the apolipoprotein system, tissue fibrosis due to increased TIMP-1 levels, activation of nonspecific inflammation, anemia and pathological polymorphism of the ApoB100 and FGA genes.