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Abstract：
BACKGROUND: Individuals with both atrial fibrillation (AF) and myocardial infarction (MI) have higher mortality compared with individuals with only 1 condition. Whether mortality differs according to the temporal order of AF and MI is unclear.
RESULTS: We included participants from the FHS (Framingham Heart Study) from 1960 and onwards. We assessed the hazard ratio (HR) of new-onset AF and MI, and mortality according to MI and AF status (prevalent and interim) using multivariable-adjusted Cox proportional hazards models. Interim diseases were modeled as time-varying variables. For the analysis of new-onset AF, 10 923 participants (55% women; mean±SD age, 54±8 years) were included. For new-onset MI, 10 804 participants (55% women; mean±SD age, 54±8 years) were included. Compared with no MI, the hazard of new-onset AF was higher in participants with prevalent (HR, 1.60 [95% CI, 1.32-1.94]) and interim MI (HR, 3.96 [95% CI, 3.18-4.91]). Both ST-segment-elevation MI and non-ST-segment-elevation MI were associated with new-onset AF. Interim AF, not prevalent AF, was associated with higher hazard rate of new-onset MI (HR, 2.21 [95% CI, 1.67-2.92]). Interim AF was associated with both ST-segment-elevation MI and non-ST-segment-elevation MI. Mortality was significantly greater among participants with AF and MI compared with participants with 1 of the 2, regardless of temporal order.
CONCLUSIONS: We report a bidirectional association between AF and MI, which was observed for both non-ST-segment-elevation MI and ST-segment-elevation MI. Participants with both AF and MI had considerably higher mortality compared with participants with only 1 of the 2 conditions, regardless of order.
RESULTS: We included participants from the FHS (Framingham Heart Study) from 1960 and onwards. We assessed the hazard ratio (HR) of new-onset AF and MI, and mortality according to MI and AF status (prevalent and interim) using multivariable-adjusted Cox proportional hazards models. Interim diseases were modeled as time-varying variables. For the analysis of new-onset AF, 10 923 participants (55% women; mean±SD age, 54±8 years) were included. For new-onset MI, 10 804 participants (55% women; mean±SD age, 54±8 years) were included. Compared with no MI, the hazard of new-onset AF was higher in participants with prevalent (HR, 1.60 [95% CI, 1.32-1.94]) and interim MI (HR, 3.96 [95% CI, 3.18-4.91]). Both ST-segment-elevation MI and non-ST-segment-elevation MI were associated with new-onset AF. Interim AF, not prevalent AF, was associated with higher hazard rate of new-onset MI (HR, 2.21 [95% CI, 1.67-2.92]). Interim AF was associated with both ST-segment-elevation MI and non-ST-segment-elevation MI. Mortality was significantly greater among participants with AF and MI compared with participants with 1 of the 2, regardless of temporal order.
CONCLUSIONS: We report a bidirectional association between AF and MI, which was observed for both non-ST-segment-elevation MI and ST-segment-elevation MI. Participants with both AF and MI had considerably higher mortality compared with participants with only 1 of the 2 conditions, regardless of order.
摘要：
背景：同时患有心房颤动（AF）和心肌梗死（MI）的个体与仅患有1种疾病的个体相比，死亡率更高。死亡率是否根据AF和MI的时间顺序而有所不同尚不清楚。
结果：我们纳入了1960年及以后的FHS（弗雷明汉心脏研究）的参与者。我们评估了新发房颤和心肌梗死的风险比（HR），使用多变量校正Cox比例风险模型,根据MI和AF状态(流行和中期)和死亡率。中期疾病被建模为时变变量。对于新发房颤的分析，10923名参与者(55%女性；平均±SD年龄，包括54±8年）。对于新发MI，10804名参与者(55%女性；平均±SD年龄，包括54±8年）。与没有MI相比，新发房颤的危险在普遍存在的参与者中更高(HR，1.60[95%CI，1.32-1.94])和中期MI(HR，3.96[95%CI，3.18-4.91]）。ST段抬高型MI和非ST段抬高型MI均与新发房颤相关。临时AF,不是普遍的AF，与较高的新发MI危险率相关(HR，2.21[95%CI，1.67-2.92]）。中期房颤与ST段抬高MI和非ST段抬高MI均相关。无论时间顺序如何，房颤和MI参与者的死亡率均明显高于2名参与者中的1名。
结论：我们报告了房颤和MI之间的双向关联，观察到非ST段抬高MI和ST段抬高MI。与仅有两种情况中的一种的参与者相比，患有AF和MI的参与者的死亡率要高得多。不管顺序。
结果：我们纳入了1960年及以后的FHS（弗雷明汉心脏研究）的参与者。我们评估了新发房颤和心肌梗死的风险比（HR），使用多变量校正Cox比例风险模型,根据MI和AF状态(流行和中期)和死亡率。中期疾病被建模为时变变量。对于新发房颤的分析，10923名参与者(55%女性；平均±SD年龄，包括54±8年）。对于新发MI，10804名参与者(55%女性；平均±SD年龄，包括54±8年）。与没有MI相比，新发房颤的危险在普遍存在的参与者中更高(HR，1.60[95%CI，1.32-1.94])和中期MI(HR，3.96[95%CI，3.18-4.91]）。ST段抬高型MI和非ST段抬高型MI均与新发房颤相关。临时AF,不是普遍的AF，与较高的新发MI危险率相关(HR，2.21[95%CI，1.67-2.92]）。中期房颤与ST段抬高MI和非ST段抬高MI均相关。无论时间顺序如何，房颤和MI参与者的死亡率均明显高于2名参与者中的1名。
结论：我们报告了房颤和MI之间的双向关联，观察到非ST段抬高MI和ST段抬高MI。与仅有两种情况中的一种的参与者相比，患有AF和MI的参与者的死亡率要高得多。不管顺序。
