Atrial Fibrillation and Myocardial Infarction: A Systematic Review and Appraisal of Pathophysiologic Mechanisms

Background: a growing body of evidence suggests that atrial fibrillation (af) is associated with myocardial infarction (mi). however,incidence and management of mi in af is still undefined. methods and results: we searched medline via pubmed and cochrane database between 1965 and 2015. all observational clinical studies and interventional trials reporting 1-year incidence of mi in af were included. we also discussed pathophysiological mechanisms,predictors,and therapeutic approaches to reduce the risk of mi in af. twenty-one observational studies and 10 clinical trials were included. the annual rate of mi in observational studies including af patients ranged from 0.4% to 2.5%. higher rates of mi were reported in af patients with stable coronary artery disease (11.5%/year),vascular disease (4.47%/year),heart failure (2.9%/year),and in those undergoing coronary artery interventions (6.3%/year). however,lower annual rates have been described in af patients from eastern countries (0.2-0.3%/year),and in those enrolled in clinical trials (from 0.4 to 1.3%/year). conclusions: af patients had a significant residual risk of mi despite anticoagulant treatment. coexistence of atherosclerotic risk factors and platelet activation account for the increased risk of mi in af. identification of high-risk af patients is a needed first step to develop cost-effective approaches for prevention. a new score,the 2mace score,has been recently developed to stratify mi risk in af,and may help not only in allocating resources to high-risk groups,but also in design of studies examining novel therapies for prevention of mi in af. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.