Prognostic Impact of Atrial Fibrillation in Acute Myocardial Infarction and Cardiogenic Shock Results From the CULPRIT-SHOCK Trial

BACKGROUND: It is unclear whether atrial fibrillation (AF) influences prognosis in patients with cardiogenic shock and multivessel disease. We aimed to investigate the prognostic impact of AF in patients with cardiogenic shock complicating acute myocardial infarction. METHODS AND RESULTS: In a subanalysis of the CULPRIT-SHOCK trial (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock), patients were grouped according to the presence of AF during index hospital stay. The primary end point was all-cause death at 30 days, and the key secondary end point was all-cause death at 1 year. AF was documented in 142 (21%) of 686 patients. AF was not a significant predictor of 30-day (adjusted odds ratio, 1.01; 95% CI 0.67-1.54; P=0.95) and 1-year (adjusted odds ratio, 0.80; 95% CI, 0.52-1.22; P=0.30) all-cause mortality. Patients with AF already on admission showed higher all-cause mortality at 30 days (52 of 90, 58% versus 19 of 52, 37%; P=0.02) and 1 year (57 of 90, 63% versus 20 of 52, 39%; P=0.004) compared with patients with newly detected AF during hospital stay. AF was associated with a longer time to hemodynamic stabilization (4, interquartile range, 1-8 days versus 3, interquartile range, 1-6 days; P=0.04) at 30 days. CONCLUSIONS: In cardiogenic shock complicating acute myocardial infarction, all-cause mortality is similar in patients with and without AF. Adverse outcome was detected in the subgroup of patients showing AF already on hospital admission.