Atrial fibrillation management strategies and early mortality after myocardial infarction

Results from the Valsartan in Acute Myocardial Infarction (VALIANT) trial

Kent R Nilsson, Sana M. Al-Khatib, Yi Zhou, Karen Pieper, Harvey D. White, Aldo P. Maggioni, Lars Kober, Christopher B. Granger, Eldrin F. Lewis, John J.V. McMurray, Robert M. Califf, Eric J. Velazquez

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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 prespecified: 0e45 days and 45e1096 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 antiarrhythmic 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.

Original languageEnglish (US)
Pages (from-to)838-842
Number of pages5
JournalHeart
Volume96
Issue number11
DOIs
StatePublished - Jun 1 2010
Externally publishedYes

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Valsartan
Atrial Fibrillation
Myocardial Infarction
Mortality
Anti-Arrhythmia Agents
Stroke
Random Allocation
Proportional Hazards Models
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Atrial fibrillation management strategies and early mortality after myocardial infarction : Results from the Valsartan in Acute Myocardial Infarction (VALIANT) trial. / Nilsson, Kent R; Al-Khatib, Sana M.; Zhou, Yi; Pieper, Karen; White, Harvey D.; Maggioni, Aldo P.; Kober, Lars; Granger, Christopher B.; Lewis, Eldrin F.; McMurray, John J.V.; Califf, Robert M.; Velazquez, Eric J.

In: Heart, Vol. 96, No. 11, 01.06.2010, p. 838-842.

Research output: Contribution to journalArticle

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 2010, '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, pp. 838-842. https://doi.org/10.1136/hrt.2009.180182
Nilsson, Kent R ; Al-Khatib, Sana M. ; Zhou, Yi ; Pieper, Karen ; White, Harvey D. ; Maggioni, Aldo P. ; Kober, Lars ; Granger, Christopher B. ; Lewis, Eldrin F. ; McMurray, John J.V. ; Califf, Robert M. ; Velazquez, Eric J. / Atrial fibrillation management strategies and early mortality after myocardial infarction : Results from the Valsartan in Acute Myocardial Infarction (VALIANT) trial. In: Heart. 2010 ; Vol. 96, No. 11. pp. 838-842.
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abstract = "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 prespecified: 0e45 days and 45e1096 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 antiarrhythmic 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.",
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T1 - Atrial fibrillation management strategies and early mortality after myocardial infarction

T2 - Results from the Valsartan in Acute Myocardial Infarction (VALIANT) trial

AU - Nilsson, Kent R

AU - Al-Khatib, Sana M.

AU - Zhou, Yi

AU - Pieper, Karen

AU - White, Harvey D.

AU - Maggioni, Aldo P.

AU - Kober, Lars

AU - Granger, Christopher B.

AU - Lewis, Eldrin F.

AU - McMurray, John J.V.

AU - Califf, Robert M.

AU - Velazquez, Eric J.

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N2 - 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 prespecified: 0e45 days and 45e1096 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 antiarrhythmic 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.

AB - 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 prespecified: 0e45 days and 45e1096 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 antiarrhythmic 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.

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