ABC | Volume 113, Nº5, November 2019

Short Editorial Scanavacca & Wu Atrial fibrillation after acute myocardial infarction Arq Bras Cardiol. 2019; 113(5):958-959 1. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic reviewof the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30(9):1038-45. 2. Jabre P, Roger VL, Murad MH, Chamberlain AM, Prokop L, Adnet F, et al. Mortalityassociatedwithatrialfibrillationinpatientswithmyocardialinfarction: a systematic reviewandmeta-analysis. Circulation. 2011;123(15):1587-93. 3. Lopes RD, Pieper KS, Horton JR, Al-Khatib SM, Newby LK, Mehta RH, et al. Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation. Heart. 2008;94(7):867-73. 4. Congo KH, Belo A, Carvalho J, Neves D, Guerreiro R, Pais JA, et al. Fibrilação Auricular de Novo no Infarto Agudo do Miocárdio com Supradesnível do Segmento ST: Preditores e Impacto na Terap utica e Mortalidade. Arq Bras Cardiol. 2019; 113(5):948-957. 5. Nilsson KR Jr, Al-Khatib SM, Zhou Y, Pieper K, White HD, Maggioni AP, et al. Atrial fibrillationmanagement strategies and earlymortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial. Heart 2010;96(11):838-42 6. Wong CK, White HD , Wilcox RG, Criger DA, Califf RM, Topol EJ, et al. Significance of atrial fibrillation during acute myocardial infarction, and its current management: insights from the GUSTO-3 trial. Card Electrophysiol Rev. 2003 Sep;7(3):201-7. 7. Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM, et al. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 1997;30:406–413. 8. Siu CW, JimMH, Ho HH, Miu R, Lee SW, Lau CP. Transient atrial fibrillation complicating acute inferior myocardial infarction: implications for future risk of ischemic stroke. Chest 2007;132:44–49. 9. LehtoM,SnapinnS,DicksteinK,SwedbergK,NieminenMS.Prognosticriskof atrial fibrillation inacutemyocardial infarctioncomplicatedby leftventricular dysfunction: the OPTIMAAL experience. Eur Heart J 2005;26:350–356. 10. January CT, Wann LS, Calkins H, Chen LY , Cigarroa JE , Cleveland JC Jr, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2019 Aug;16(8):e66-e93. 11. Kirchhof P , Benussi S, Kotecha D , Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-962. 12. Cannon CP, Bhatt DL, Oldgren J, Lip GYH, Ellis SG, Kimura T, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377(16):1513–24. 13. Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016;375(25):2423–34. 14. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, et al. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med 2019;380(16):1509-24. 15. Vranckx P , Valgimigli M, Eckardt L, Tijssen J, Lewalter T , Gargiulo G, et al. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen aftersuccessfulcoronarystenting inpatientswithatrial fibrillation (ENTRUST- AF PCI): a randomised, open-label, phase 3b trial. Lancet.  2019; 394(10206):1335-43. 16. Lopes RD, Hong H, Harskamp RE, Bhatt DL, Mehran R, Cannon CP , et al. Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials. JAMA Cardiol. 2019 Jun 19. [Epub ahead of print] 17. PotparaTS, MujovicN, ProiettiM, DagresNH indricksG, ColletJP ,etal.Revisiting the effects of omitting aspirin in combined antithrombotic therapies for atrial fibrillationandacutecoronarysyndromesorpercutaneouscoronaryinterventions: meta-analysis of pooled data from the PIONEER AF-PCI, RE-DUAL PCI, and AUGUSTUStrials. Europace. 2019Oct11.pii:euz259.[Epubaheadofprint]. 18. RomanovA,MartinekM,PurerfellnerH,ChenS,DeMellisM,GrazhdankinI, etal.Incidenceofatrialfibrillationdetectedbycontinuousrhythmmonitoring after acute myocardial infarction in patients with preserved left ventricular ejection fraction:resultsoftheARRESTstudy.Europace. 2018;20(2):263-70. References in 1.8% and 0.5% of patients with or without AF, respectively. In addition, the this study did not provide data on the use of anticoagulants after hospital discharge. Hence, Siu et al. 8 analyzed 431 consecutive patients with inferior wall AMI and preserved ventricular function. They found that transient new‑onset AF during hospitalization was observed in 59 patients (13.9%). Over a mean follow-up period of one year, the incidence of AF was of 22% in patients with transitory AF in admission, compared with 1.3% (p = 0.01) in the group without AF and, even more importantly, the incidence of ischemic stroke was of 10.2% in patients with transitory AF and of 1.8% in those without AF (p=0.01). It is worth highlighting that the patients with AF did not receive anticoagulants, only antiplatelet agents. Similar findings were obtained in the Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan (OPTIMAAL) trial 9 in patients with AMI and ventricular dysfunction, in which the presence of new onset AF was also associated with increased risk of stroke in the first 30 days (HR 14.6, p< 0.001) and during the whole period of observation of the study (HR 2.29, p < 0.001). Current guidelines recommend that patients with acute coronary syndrome and AF should receive anticoagulant therapy (warfarin or NOACs), associated with aspirin and/or clopidogrel for at least 6 months, except if they are absolutely contraindicated. 10,11 However, the studies that support it are based on the existence of known AF or AF prior to the coronary event. 12-17 In the absence of randomized clinical trials, it seems reasonable that this recommendation should also be applied to the patients who presented with a first-episode AF in the acute phase of AMI, particularly in those with high-risk predictors of recurrence and with elevated CHA 2 DS 2- VASc score. 18 This is an open-access article distributed under the terms of the Creative Commons Attribution License 959