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Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial.

Publication ,  Journal Article
Nilsson, KR; Al-Khatib, SM; Zhou, Y; Pieper, K; White, HD; Maggioni, AP; Kober, L; Granger, CB; Lewis, EF; McMurray, JJV; Califf, RM; Velazquez, EJ
Published in: Heart
June 2010

OBJECTIVE: The management of patients with atrial fibrillation (AF) following a myocardial infarction (MI) remains uncertain. This study compared a rate control strategy to an anti-arrhythmic-based rhythm control strategy for the treatment of AF following myocardial infarction. DESIGN, SETTING AND PATIENTS: We studied 1131 patients with AF after MI who were enrolled in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). We classified patients into those treated with a rhythm control strategy (n=371) and those treated with a rate control strategy (n=760). MAIN OUTCOMES MEASURES: Using Cox models, we compared the two groups with respect to both death and stroke during two different time periods after randomisation for which data collection had been pre-specified: 0-45 days and 45-1096 days. RESULTS: After adjustment, a rhythm control strategy was found to be associated with increased early mortality (0-45 days: HR: 1.9, 95% CI 1.2 to 3.0, p=0.004) but not late mortality (45-1096 days: HR 1.1, 95% CI 0.9 to 1.4, p=0.45). No difference was observed in the incidence of stroke (0-45 days: HR 1.2, 95% CI 0.4 to 3.7, p=0.73; 45-1096 days: HR 0.6, 95% CI 0.3 to 1.3, p=0.21). CONCLUSIONS: In patients with AF after an MI, an anti-arrhythmic drug-based rhythm control strategy is associated with excess 45-day mortality compared with a rate control strategy, but is not associated with increased mortality outside of the immediate peri-infarct period. These results potentially identify a patient population in whom the use of anti-arrhythmic drug therapy may portend an increased risk of death.

Duke Scholars

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2010

Volume

96

Issue

11

Start / End Page

838 / 842

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke
  • Myocardial Infarction
  • Male
  • Humans
  • Heart Failure
  • Female
  • Epidemiologic Methods
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
 

Citation

APA
Chicago
ICMJE
MLA
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Nilsson, K. R., Al-Khatib, S. M., Zhou, Y., Pieper, K., White, H. D., Maggioni, A. P., … Velazquez, E. J. (2010). Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial. Heart, 96(11), 838–842. https://doi.org/10.1136/hrt.2009.180182
Nilsson, Kent R., Sana M. Al-Khatib, Yi Zhou, Karen Pieper, Harvey D. White, Aldo P. Maggioni, Lars Kober, et al. “Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial.Heart 96, no. 11 (June 2010): 838–42. https://doi.org/10.1136/hrt.2009.180182.
Nilsson, Kent R., et al. “Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial.Heart, vol. 96, no. 11, June 2010, pp. 838–42. Pubmed, doi:10.1136/hrt.2009.180182.
Nilsson KR, Al-Khatib SM, Zhou Y, Pieper K, White HD, Maggioni AP, Kober L, Granger CB, Lewis EF, McMurray JJV, Califf RM, Velazquez EJ. Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial. Heart. 2010 Jun;96(11):838–842.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2010

Volume

96

Issue

11

Start / End Page

838 / 842

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke
  • Myocardial Infarction
  • Male
  • Humans
  • Heart Failure
  • Female
  • Epidemiologic Methods
  • Cardiovascular System & Hematology
  • Atrial Fibrillation