Cardiorenal relationships in the focus of risks of atrial fibrillation in patients after acute ST-elevated myocardial infarction (observational program FAKEL)

Aim. To study markers of renal dysfunction in relation to the likelihood of atrial fibrillation (AF) in patients after ST-segment elevated myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Material and methods. The study was conducted with the inclusion of 1 52 patients discharged for outpatient monitoring after STEMI. There were 4 visits: V₁ - inclusion visit, V₂ - in 12 months, V₃ - in 18 months, V₄- in 24 months with determination of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), cystatin C, erythropoietin, galectin-3, von Willebrand factor (fW), left ventricular ejection fraction. Endpoint: new cases of AF, cardioembolic stroke, deaths.

Results. After 24 months 35 patients (23.0%) were diagnosed with AF, 6 of them (3.9%) - developed cardioembolic stroke. The multivariate model of risk factors for AF included indicators: cystatin C (odds ratio [OR] 1.31; 95% confidence interval [95%CI] 1.03-1.67), NT-ProBNP (OR 1.11; 95%CI 1.03-1.19), galectin-3 (OR 0.71; 95%CI 0.55-0.91), fV (OR 0.71; 95%CI 0.55-0.91).

Conclusion. The prognostic significance of cystatin C in relation to the risk of AF was established, which should be considered when assessing the prognosis in patients after STEMI.

1. Schmitt J., Duray G., Gersch B.J. et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009; 30:1038-45. doi:10.1093/eurheartj/ehn579.

2. Jabre P., Roger VL., Murad M.H., et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. 2011;1 23:1 587-93. doi:10.1161/CIRCULATIONAHA.110.986661.

3. Angeli F, Reboldi G., Garofoli M., et al. Atrial fibrillation and mortality in patients with acute myocardial infarction: a systematic overview and meta-analysis. Curr Cardiol Rep. 2012;14:601-10. doi:10.1007/s11886-012-0289-3.

4. Schmitt J., Duray G., Gersh B.J., Hohnloser S.H. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30:1038-45. doi:10.1093/eurheartj/ehn579.

5. Zhang Y, Zhang L., Zheng H., et al. Effects of atrial fibrillation on complications and prognosis of patients receiving emergency PCI after acute myocardial infarction. Exp Ther Med. 2018;16(4):3574-8. doi:10.3892/etm.2018.6640.

6. Chaudhary N., Bundhun P.K., Yan H. Comparing the clinical outcomes in patients with atrial fibrillation receiving dual antiplatelet therapy and patients receiving an addition of an anticoagulant after coronary stent implantation: A systematic review and meta-analysis of observational studies. Medicine (Baltimore). 2016;95:e5581. doi:10.1097/MD.0000000000005581.

7. . Hudzik B., Szkodzinski J., Hawranek M., et al. CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation. Acta Diabetol. 2016;53:807-81 5. doi: 10.1007/s00592-016-0877-6.

8. Masuda M., N a kata n i D., Hikoso S., et al. OACIS Investigators: Clinical impact of ventricular tachycardia and/or fibrillation during the acute phase of acute myocardial infarction on in-hospital and 5-year mortality rates in the percutaneous coronary intervention era. Circ J. 2016;80:1 539-47. doi:10.1253/circj.CJ-16-0183.

9. Cannon C.P., Gropper S., Bhatt D.L., et al. RE-DUAL PCI Steering Committee and Investigators: Design and Rationale of the RE-DUAL PCI ТМ A prospective, randomized, phase 3b study comparing the safety and efficacy of dual antithrombotic therapy with dabigatran etexilate versus warfarin triple therapy in patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stenting. Clin Cardiol. 2016;39:555-64. doi:10.1002/clc.22572.

10. Romanov A., Grazhdankin I., Ponomarev D., et al. Incidence of atrial fibrillation detected by continuous rhythm monitoring after acute myocardial infarction in patients with preserved left ventricular ejection fraction: results of the ARREST study. Europace. 2018;20(2):263-70. doi:10.1093/eu-ropace/euw344.

11. Zolotovskaya I.A., Davydkin 1.1., Duplyakov D.V, Kokorin V.A. Predictive markers of atrial fibrillation in patients after acute ST-elevated myocardial infarction (the results of observational program "FAKEL”), Cardiovascular Therapy and Prevention. 2018;17(5):25-33 (In Russ.) doi:10.15829/1728-8800-2018-5-25-33.

12. Ronco C. Cardiorenal syndromes: definition and classification. Contrib Nephrol. 2010; 164:33-8, doi:10.1159/000313718.

13. Srivastava A., Kaze A.D., McMullan C.J. et al. Uric acid and the risks of kidney failure and death in individuals with CKD. Am J Kidney Dis. 2017;71:362-70. doi:10.1053/j.ajkd.2017.08.017.

14. Keith D.S., Nichols G.A., Gullion C.M. et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164:659-63. doi:10.1001/archinte.164.6.659.

15. Fan Z., Li Y, Ji H., Jian X. Nomogram Model to Predict Cardiorenal Syndrome Type 1 in Patients with Acute Heart Failure. Kidney Blood Press Res. 2018;43(6):1832-41. doi:10.1159/0004958.

16. Hou FF, Yang X. Advances in the Management of Acute Cardiorenal Syndrome in China: Biomarkers for Predicting Development and Outcomes. Kidney Dis (Basel). 2017;2:145-50. doi:10.1159/000449026.

17. George L.K., Koshy S.K.G., Molnar M.Z., et al. Heart Failure Increases the Risk of Adverse Renal Outcomes in Patients with Normal Kidney Function. Circ Heart Fail. 2017;10:pii:e003825. doi: 10.1161/CIRCHEARTFAILURE.116.003825.

18. . Thind G.S., Loehrke M., Wilt J.L. Acute cardiorenal syndrome: Mechanisms and clinical implications. Cleve Clin J Med. 2018;85:231-9. doi:10.3949/ccjm.85a.17019.

19. Nakada Y, Kawakami R., Matsui M., et al. Prognostic Value of Urinary Neutrophil Gelatinase-Asso-ciated Lipocalin on the First Day of Admission for Adverse Events in Patients With Acute Decompensated Heart Failure. J Am Heart Assoc. 2017;6:pii:e004582. doi:10.1161/JAHA.116.004582.

20. Shirakabe A., Hata N., Kobayashi N., et al. Clinical Usefulness of Urinary Liver Fatty Acid-Binding Protein Excretion for Predicting Acute Kidney Injury during the First 7 Days and the Short-Term Prognosis in Acute Heart Failure Patients with Non-Chronic Kidney Disease. Cardiorenal Med. 2017;7:301 -15. doi:10.1159/000477825,

21. Gai J.J., Gai L.Y, Liu H.B., et al. Correlation of heart and kidney biomarkers to the pathogenesis of cardiorenal syndrome. Nan Fang Yi Ke Da Xue Xue Bao. 2010;30(5):1 122-6.

22. Frangogiannis N.G. The inflammatory response in myocardial injury, repair, and remodeling. Nat Rev Cardiol. 2014;1 1:255-65. doi:10.1038/nrcardio.2014.28.

23. Kawashima C., Matsuzawa Y, Akiyama E. et al. Prolonged Fever After ST-Segment Elevation Myocardial Infarction and Long-Term Cardiac Outcomes. J Am Heart Assoc. 2017;6(7):pii: e005463. doi: 10.1161/JAHA.116.005463.

24. Lee S.H., Park S.A., Ko S.H. et al. Insulinresistance and inflammation may have an additional role in the link between cystatin C and cardiovascular disease in type 2 diabetes mellitus patients. Metabolism. 2010;59(2):241-6. doi:10.1016/j.metabol.2009.07.019.

25. Smith J.G., Newton-Cheh C., Almgren P. et al. Assessment of conventional cardiovascular risk factors and multiple biomarkers for the prediction of incident heart failure and atrial fibrillation. J Am Col Cardiol. 2010;56(21):1712-9. doi:10.1016/j.jacc.2010.05.049.