La fibrillation auriculaire de novo après un syndrome coronarien aigu: Prévalence et facteurs prédictifs
Résumé
Introduction : La fibrillation atriale (FA) de novo complique souvent les syndromes coronaires aigus (SCA) dont l’association semble
être mutuellement délétère. La prévalence de la FA de novo chez les patients hospitalisés pour SCA est variable entre 2 et 37% selon les
différentes études. Plusieurs facteurs prédictifs ont été incriminés dans la littérature mais restent un sujet de controverse
Objectif : Déterminer la prévalence de la FA de novo chez des patients hospitalisés pour SCA et identifier ses facteurs prédictifs.
Méthodes : Nous avons réalisé une étude observationnelle prospective, descriptive et comparative menée chez des patients hospitalisés
pour SCA et qui n’avaient pas un diagnostic antérieur de FA.
Résultats : Dans notre travail, nous avons inclus 404 patients hospitalisés pour SCA.La prévalence de la FA de novo était de 10%. Dans
l’étude analytique multivariée, nous avons retenu comme facteurs prédictifs indépendants de la FA de novo : un âge supérieur à 62 ans
(p=0,04 ;OR ajusté=4,83 ; IC95% : 1,07-21,77), l’insuffisance rénale chronique (p=0,043 ; OR ajusté=6,61 : IC95% : 1,06-35,80), les
antécédants d’ accident vasculaire cérébral (p=0,002 ; OR ajusté=44,51 ; IC95% : 3,97-498,10) et enfin une uricémie supérieure ou égale
à 62 mg /l (p=0,04 ; OR ajusté=4,4 ; IC95% : 1,06-18,15).
Conclusions : La prévalence de la FA de novo chez les patients présentant un SCA était de 10%. Son dépistage systématique chez ces
patients se présente ainsi comme une approche pertinente vu la forte association entre les deux pathologies.
Téléchargements
Références
Hasdai D, Behar S, Wallentin L, Danchin N, Gitt AK, Boersma E, et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J 2002;23(15):1190‑201.
Batra G, Svennblad B, Held C, Jernberg T, Johanson P, Wallentin L, et al. All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. Heart Br Card Soc 2016;102(12):926‑33.
Wang J, Yang Y-M, Zhu J. Mechanisms of new-onset atrial fibrillation complicating acute coronary syndrome. Herz 2015;40(1):18‑26.
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA 2001;285(18):2370‑5.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22(8):983‑8.
Eldar M, Canetti M, Rotstein Z, Boyko V, Gottlieb S, Kaplinsky E, et al. Significance of Paroxysmal Atrial Fibrillation Complicating Acute Myocardial Infarction in the Thrombolytic Era. Circulation 1998;97(10):965‑70.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with STsegment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39(2):119‑77.
Thygesen K, Alpert JS., Jaffe AS., Chaitman R., Bax J., Morrow A., et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation 2018;138(20):e618‑51.
Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/ non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000;284(7):835‑42.
Fox KAA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 2006;333(7578):1091.
Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163(19):2345‑53.
Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factorbased approach: the euro heart survey on atrial fibrillation. Chest 2010;137(2):263‑72.
Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, et al. Baseline risk of major bleeding in non-STsegment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation 2009;119(14):1873‑82.
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010;138(5):1093‑100.
The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82
Wong CK, White HD, Wilcox RG, et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J 2000;140(6: 878‑85.
Kinjo K, Sato H, Sato H, et al. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol 2003;92(10):1150‑4.
Lin C-J, Liu C-F, Kung C-T, Sun C-K, Lin Y-C, Leu S, et al. The prognostic value of atrial fibrillation on 30-day clinical outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int Heart J 2011;52(3):153‑8.
Congo KH, Belo A, Carvalho J, Neves D, Guerreiro R, Pais JA, et al. New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And Mortality. Arq Bras Cardiol 2019;113(5):948‑57.
Thomsen P, Jons C, Raatikainen MJ. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction : the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study. Circulation 2010;122(13) :1258-64
Jons C, Raatikainen P, Gang UJ, Huikuri HV, Joergensen RM, Johannesen A, et al. Autonomic Dysfunction and New-Onset Atrial Fibrillation in Patients With Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction: A CARISMA Substudy. J Cardiovasc Electrophysiol 2010;21(9):983‑90.
Yoshizaki T, Umetani K, Ino Y, Takahashi S, Nakamura M, Seto T, et al. Activated inflammation is related to the incidence of atrial fibrillation in patients with acute myocardial infarction. Intern Med Tokyo Jpn 2012;51(12):1467‑71.
Wong C-K, White HD, Wilcox RG, Criger DA, Califf RM, Topol EJ, et al. Significance of atrial fibrillation during acute myocardial infarction, and its current management: insights from the GUSTO-3 trial. Card Electrophysiol Rev 2003;7(3):201-7
Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 2000;101(9):969‑74.
Gorczyca-Michta I, Wożakowska-Kapłon B, Tomasik E. Prevalence and predisposing conditions for atrial fibrillation in hospitalised patients with hypertension. Kardiol Pol 2013;71(4):352‑8.
Jin YY, Bai R, Ye M, Ai H, Zeng YJ, Nie SP. Risk factors and prognoses analysis of new-onset atrial fibrillation in patients with acute myocardial infarction . Zhonghua Nei Ke Za Zhi 2019;58(2):133‑8.
27 Mrdovic I, Savic L, Krljanac G, Perunicic J, Asanin M, Lasica R, et al. Incidence, predictors, and 30-day outcomes of new-onset atrial fibrillation after primary percutaneous coronary intervention: insight into the RISK-PCI trial. Coron Artery Dis 2012;23(1):1‑8.
Bahouth F, Mutlak D, Furman M, Musallam A, Hammerman H, Lessick J, et al. Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction. Heart Br Card Soc 2010;96(9):683‑8.
Stachon P, Ahrens I, Faber T et al. Asymptomatic atrial fibrillation and risk of stroke. Panminerva Med 2015;57(4):211-5.
Karataş M, Çangaa Y, İpeka G. Association of admission serum laboratory parameters with new-onset atrial fibrillation after a primary percutaneous coronary intervention. Coronary Artery Disease 2016;27:128–134.
Yildrim E, Ermis E, Allahverdiyev S et al. Value of syntax score II in Prediction of New-Onset Atrial Fibrillation in Patients with NSTE-ACS Undergoing Percutaneous Coronary intervention. Angiology 2019;70(9):860-866.
Yoshizaki T, Umetani K, Ino Y, Takahashi S, Nakamura M, Seto T, et al. Activated inflammation is related to the incidence of atrial fibrillation in patients with acute myocardial infarction. Intern Med Tokyo Jpn
