Objective: The aim of this study is to examine the prognostic impact of decreased kidney function at admission on the occurrence of new-onset AF in patients with STEMI treated with primary PCI (pPCI).
Method: The study enrolled 3,115 consecutive STEMI patients. Kidney function was assessed by estimation of the glomerular filtration rate (eGFR) at admission. Patients with cardiogenic shock at admission, patients on hemodialysis and patients with medical history of previous AF (paroxysmal, persistent or permanent) were excluded. The follow-up period was 6 years.
Results: New-onset AF occurred in 215 (6.9%) patients; 75 (34.9%) patients presented with AF, and 140 (65.1%) patients developed AF after pPCI. The median time of AF occurrence in patients who did not present with AF was 4.5h (IQR 1-25h) after pPCI. New-onset AF was associated with a higher short- and long-term mortality. In the multiple logistic regression analysis, all stages of reduced kidney function were independent predictors for the occurrence of new-onset AF, and negative prognostic impact increased with the deterioration of kidney function: eGFR<90ml/min/m2 HR1.96, 95%CI 1.42-2.89, p=0.011; eGFR 60-89 ml/min/m2 HR1.54, 95%CI 1.13-2.57, p=0.045; eGFR 45-59ml/min/m2 HR 2.09, 95%CI 1.24-2.85, p=0.023; eGFR 30-44 ml/min/m2 HR2.93, 95%CI 1.64-5.29, p<0.001; eGFR 15-29 ml/min/m2 HR 5.51, 95%CI 2.67-11.39, p<0.001.
Conclusion: Decreased kidney function was significantly associated with the occurrence of new-onset AF, and its impact increased with the deterioration of kidney function, starting with the eGFR value of 90ml/min/m2. New-onset AF was an independent predictor of long-term all-cause mortality in the analyzed patients.