scholarly journals Compared prognostic impact of incident atrial fibrillation versus history of atrial fibrillation in patients with AMI: the FAST-MI programme

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Danchin ◽  
L Fauchier ◽  
E Marijon ◽  
T Lavergne ◽  
S Boveda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Acute Stage ◽  
Funding Source ◽  
Prognostic Impact ◽  
Risk Of Death ◽  
Fatal Stroke ◽  
Increased Risk ◽  
History Of ◽  
Using Data

Abstract Background History of atrial fibrillation (HxAF) and new onset atrial fibrillation (NOAF) at acute stage of MI are associated with poorer survival. Whether both entities carry an increased risk of stroke is uncertain. Using data from the FAST-MI 2010 and 2015 registries, we analysed the associations between HxAF and NOAF and risk of 3-year death, nonfatal stroke or combined death or stroke. Methods The FAST-MI registries are nationwide French cohorts consecutively including AMI patients admitted over a 1-month period every 5 years. Baseline characteristics, acute management and medications at discharge are collected. Among 9460 patients with STEMI or NSTEMI, 610 (6.4%) had HxAF, and 626 (6.6%) developed NOAF. Main characteristics Table 1 Overall, NOAF was associated with larger and more severe AMIs. Results In hospital survivors, 3-year death was 8.6% in patients without AF, 23.2% in those with NOAF and 29.2% in those with HxAF. 3-year Kaplan-Meier rates of non-fatal stroke were 1.1%, 0.3% and 3.6%, respectively (Figure). Compared with no AF, NOAF was not associated with non-fatal stroke (Cox HR, 95% CI: 0.17, 0.02–1.21), while HxAF was (HR, 95% CI 2.04, 1.13–3.66, P=0.017). Risk of death or stroke was increased for both NOAF (HR, 95% CI 1.35, 1.10–1.65, P=0.004) and HxAF (HR 95% CI, 1.37, 1.14–1.65, P=0.001). Risk of all-cause death at 3 years was increased for NOAF (HR, 95% CI 1.32, 1.09–1.60) and HxAF (HR, 95% CI 1.30, 1.09–1.55). The results were concordant in patients not receiving oral anticoagulants at discharge. Conclusion Both NOAF and HxAF are associated with increased risk of death at 3 years after AMI. NOAF, however, is not associated with an increased risk of non-fatal stroke. Figure 1. Non-fatal stroke Funding Acknowledgement Type of funding source: Other. Main funding source(s): Pharma companies

scholarly journals New Oral Anticoagulants vs. Vitamin K Antagonists Among Patients With Cardiac Amyloidosis: Prognostic Impact

2021 ◽  
Vol 8 ◽  
Author(s):  
Eve Cariou ◽  
Kevin Sanchis ◽  
Khailène Rguez ◽  
Virginie Blanchard ◽  
Stephanie Cazalbou ◽  
...  
Keyword(s):  
Vitamin K ◽  
Cardiac Amyloidosis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Bleeding Complications ◽  
Prognostic Impact ◽  
Transthyretin Amyloidosis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
History Of

Background: Atrial arrhythmia (AA) is common among patients with cardiac amyloidosis (CA), who have an increased risk of intracardiac thrombus. The aim of this study was to explore the prognostic impact of vitamin K-antagonists (VKA) and direct oral anticoagulants (DOAC) in patients with CA.Methods and Results: 273 patients with CA and history of AA with long term anticoagulation−69 (25%) light chain amyloidosis (AL), 179 (66%) wild-type transthyretin amyloidosis (ATTRwt) and 25 (9%) variant transthyretin amyloidosis (ATTRv)–were retrospectively included between January 2012 and July 2020. 147 (54%) and 126 (46%) patients received VKA and DOAC, respectively. Patient receiving VKA were more likely to have AL with renal dysfunction, higher NT-proBNP and troponin levels. Patients with ATTRwt were more likely to receive DOAC therapy. There were more bleeding complications among patients with VKA (20 versus 10%; P = 0.013) but no difference for stroke events (4 vs. 2%; P = 0.223), as compared to patients with DOAC. A total of 124 (45%) patients met the primary endpoint of all-cause mortality: 96 (65%) and 28 (22%) among patients with VKAs and DOACs, respectively (P < 0.001). After multivariate analysis including age and renal function, VKA was no longer associated with all-cause mortality.Conclusion: Among patients with CA and history of AA receiving oral anticoagulant, DOACs appear to be at least as effective and safe as VKAs.

scholarly journals Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001726
Author(s):  
Anthony P Carnicelli ◽  
Ruth Owen ◽  
Stuart J Pocock ◽  
David B Brieger ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
History Of ◽  
The Impact

ObjectiveAtrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF.Methods/resultsThe prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality.ConclusionsIn stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF.Trial registration numberClinicalTrials: NCT01866904.

scholarly journals Atrial Fibrillation, Oral Anticoagulants, and Concomitant Active Cancer: Benefits and Risks

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e176-e182
Author(s):  
Adriano Atterman ◽  
Leif Friberg ◽  
Kjell Asplund ◽  
Johan Engdahl
Keyword(s):  
Atrial Fibrillation ◽  
Cancer Patients ◽  
Lower Risk ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Bleeding Events ◽  
Risk Of Death ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Active Cancer

Abstract Aim To determine to what extent active cancer influences the benefit–risk relationship among patients with atrial fibrillation receiving oral anticoagulants for stroke prevention. Methods In this cohort study of all patients with atrial fibrillation in the Swedish Patient register during 2006 to 2017, 8,228 patients with active cancer and 323,394 without cancer were followed up to 1 year after initiation of oral anticoagulants. Cox regression models, adjusting for confounders and the competing risk of death, were used to assess risk of cerebrovascular and bleeding events. Results Among patients treated with oral anticoagulants, the risk for cerebrovascular events did not differ between cancer patients and noncancer patients (subhazard ratio [sHR]: 1.12, 95% confidence interval [CI]: 0.98–1.29). Cancer patients had a higher risk for bleedings (sHR: 1.69, CI: 1.56–1.82), but not for fatal bleedings (sHR: 1.17, CI: 0.80–1.70). Use of nonvitamin K oral anticoagulants was associated with lower risk of both cerebrovascular events and bleedings compared with warfarin. Conclusion Patients with atrial fibrillation and active cancer appear to have similar net cerebrovascular benefit of oral anticoagulant treatment to patients without cancer, despite an increased risk of nonfatal bleedings. Use of nonvitamin K oral anticoagulants was associated with lower risk of all studied outcomes.

scholarly journals Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Fauchier ◽  
A Bisson ◽  
A Bodin ◽  
J Herbert ◽  
T Genet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

Biomarkers Associated with Bleeding Risk in the Setting of Atrial Fibrillation

2019 ◽  
Vol 26 (5) ◽  
pp. 824-836 ◽  
Author(s):  
Skevos Sideris ◽  
Stefanos Archontakis ◽  
George Latsios ◽  
George Lazaros ◽  
Konstantinos Toutouzas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Large Scale ◽  
Oral Anticoagulants ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Hepatic Function ◽  
Risk Scores ◽  
Current Evidence ◽  
Prognostic Impact ◽  
Increased Risk

Background: Prevention of thromboembolic disease, mainly stroke, with oral anticoagulants remains a major therapeutic goal in patients with atrial fibrillation. Unfortunately, despite the high efficacy, anticoagulant therapy is associated with a significant risk of, frequently catastrophic, and hemorrhagic complications. Among different clinical and laboratory parameters related to an increased risk of bleeding, several biological markers have been recognized and various risk scores for bleeding have been developed. Objectives/Methods: The aim of the present study is to review current evidence regarding the different biomarkers associated with raised bleeding risk in atrial fibrillation. Results: Data originating from large cohorts or the recent large-scale trials of atrial fibrillation have linked numerous individual biomarkers to an increased bleeding risk. Such a relation was revealed for markers of cardiac physiology, such as troponin, BNP and NT-proBNP, markers of renal function, such as GFR and Cystatin or hepatic function, markers involving the system of coagulation, such as D-dimer and Von Willebrand factor, hematologic markers, such as low haemoglobin or low platelets, inflammatory markers, such as interleukin-6, other factors such as GDF-15 and vitamin-E and finally genetic polymorphisms. Many such biomarkers are incorporated in the bleeding risk schemata developed for the prediction of the hemorrhagic risk. Conclusions: Biomarkers were introduced in clinical practice in order to better estimate the potential risk of haemorrhage in these patients and increase the prognostic impact of clinical risk scores. In the last years this concept is gaining significant importance.

Anticoagulation in patients with atrial fibrillation undergoing coronary stent implantation

2013 ◽  
Vol 110 (09) ◽  
pp. 560-568 ◽  
Author(s):  
Anne Bernard ◽  
Céline Pellegrin ◽  
Nicolas Clementy ◽  
Christophe Saint Etienne ◽  
Amitava Banerjee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stent Implantation ◽  
Target Lesion ◽  
Coronary Stent ◽  
Cardiac Events ◽  
Risk Of Death ◽  
Coronary Stent Implantation ◽  
Increased Risk ◽  
History Of ◽  
Artery Disease

SummaryIn patients with atrial fibrillation (AF) undergoing coronary stent implantation, the optimal antithrombotic strategy is unclear. We evaluated whether use of oral anticoagulation (OAC) was associated with any benefit in morbidity or mortality in patients with AF, high risk of thromboembolism (TE) (CHA2DS2-VASC score ≥2) and coronary stent implantation. Among 8,962 unselected patients with AF seen between 2000 and 2010, a total of 2,709 (30%) had coronary artery disease and 417/2,709 (15%) underwent stent implantation while having CHA2DS2-VASC score ≥2. During follow-up (median=650 days), all TE, bleeding episodes, and major adverse cardiac events (i.e. death, acute myocardial infarction, target lesion revascularisation) were recorded. At discharge, 97/417 patients (23%) received OAC, which was more likely to be prescribed in patients with permanent AF and in those treated for elective stent implantation. The incidence of outcome event rates was not significantly different in patients treated and those not treated with OAC. However, in multivariate analysis, the lack of OAC at discharge was independently associated with increased risk of death/stroke/systemic TE (relative risk [RR] =2.18, 95% confidence interval [CI] 1.02-4.67, p=0.04), with older age (RR =1.12, 1.04-1.20, p=0.003), heart failure (RR =3.26, 1.18-9.01, p=0.02), and history of stroke (RR =18.87, 3.11-111.11, p=0.001). In conclusion, in patients with AF and high thromboembolic risk after stent implantation, use of OAC was independently associated with decreased risk of subsequent death/stroke/systemic TE, suggesting that OAC should be systematically used in this patient population.

Association of a history of falls or syncope with intracranial bleeding in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Oqab ◽  
A Alak ◽  
W.F McIntyre ◽  
Y.Y Liu ◽  
S.J Connolly ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Major Bleeding ◽  
Permanent Disability ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
Serious Injury ◽  
Critical Injury

Abstract Background In patients with atrial fibrillation (AF), anticoagulation effectively reduces the risk of ischemic stroke. However, up to 50% of patients are not receiving this treatment. A history of falls or syncope and an associated risk of intracranial hemorrhage are commonly reported reasons for undertreatment, though these have not been well studied. Purpose To investigate the association of a history of falls or syncope with the risk of intracranial hemorrhage in patients with AF. Methods Patients with a history of AF from the RE-LY, AVERROES and ACTIVE A and W trials were combined into a large cohort. “Critical injury” was defined as any injury that resulted in death, was deemed to be life-threatening or resulted in permanent disability. A “serious injury” was defined as an injury that required hospitalization. “Other injuries” were defined as those that did not meet criteria for critical or serious injury. We used logistic regression and propensity-matched Cox models to assess the association between falls or syncope and adverse outcomes. Results Among 37,973 patients, 11.9% (n=4503) had a history of falls, 17.5% (n=6655) had a history of syncope and 25.1% (n=9518) had a history of either falls or syncope. The mean age of the cohort was 71±9.3 years and 58% were male. The median CHADS2 score was 2. A history of falls or syncope was not associated with the risk of incident intracranial hemorrhage (HR 1.11, 95% CI 0.88–1.4). In propensity-matched multivariable models, a history of falls or syncope was associated with an increased risk of death (HR 1.14, 95% CI 1.07–1.22), stroke (HR 1.17, 95% CI 1.05–1.3), myocardial infarction (HR 1.28, 95% CI 1.09–1.52) and major bleeding (HR 1.27, 95% CI 1.16–1.4). Moreover, a history of falls or syncope was associated with increased risk of critical injury (OR 1.97, 95% CI 1.52–2.54), serious injury (OR 2.06, 95% CI 1.75–2.43) and “other injury” (OR 1.58, 95% CI 1.46–1.72). Conclusions A history of falls or syncope is common in patients with atrial fibrillation; however, neither history was associated with increased risk of intracranial hemorrhage. These patients were at an increased risk of death, stroke, myocardial infarction and major bleeding, suggesting that they should receive anticoagulation for stroke prevention. Funding Acknowledgement Type of funding source: None

Permanent discontinuation of different anticoagulants in patients with atrial fibrillation and the impact on clinical outcome: data from the GARFIELD-AF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Cools ◽  
D Johnson ◽  
K.S Pieper ◽  
A.J Camm ◽  
J.-P Bassand ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Time Dependent ◽  
Funding Source ◽  
Increased Risk ◽  
History Of ◽  
Baseline Factors ◽  
The Impact

Abstract Background Non-Vitamin K Antagonists (NOAC) are replacing vitamin K Antagonists (VKA) as first line oral anticoagulant therapy (OAC) in patients with non-valvular atrial fibrillation (NVAF). Discontinuation of OAC might put patients at increased risk. It was anticipated that patients who were on NOAC would discontinue OAC less. Purpose We compare the rates and impact on outcome of the discontinuation of NOAC and VKA using data from the GARFIELD-AF registry. Methods Patients included in GARFIELD-AF, had a new diagnosis of NVAF and at least 1 stroke risk factor. In this analysis 26,299 patients (VKA: 13,012; NOAC: 13,287) that received OAC were included. Permanent discontinuation was defined as stopping OAC for at least 7 consecutive days (whether or not restarted during follow-up). Marginal structural Cox proportional hazards models estimated the effect of discontinuation on death, cardiovascular (CV) death, non-haemorrhagic stroke + systemic embolism (NHS+SE), myocardial infarction (MI), or combined endpoints. Adjustments were made for both baseline factors and time dependent variables. Results Of all patients, 15.6% discontinued OAC (VKA: 15.4%; NOAC: 15.8%) over a median follow-up of 181 days (IQR: 359). Most discontinued early (67.0% of patients on VKA and 47.1% of patients on NOAC ≤4 months). Significantly higher discontinuation risk was seen with worsening kidney function, coronary artery disease, history of bleeding (baseline factors), as well as with all types of bleeding (time dependent factors). Lower discontinuation rates were seen with history of stroke/TIA, hypertension, increasing age, permanent AF (all p<0.01). Mean CHA2DS2-VASc score was 3 in all groups. Patients in both treatment arms who discontinued were at increased risk for death, NHS+SE, MI as well as combined endpoints of death/NHS+SE/MI, death/NHS+SE and a trend towards higher CV death (Figure 1). All interaction tests for the interaction of treatment and discontinuation had a p value >0.4. The association between discontinuation and outcomes did not change when a 30 day discontinuation window was used. Conclusion The rate of discontinuation in this study was 15.8% and comparable for VKA and NOAC over a 2-year follow-up. Discontinuation rates were the highest soon after the initiation of treatment. When VKA or NOAC was stopped for ≥7 consecutive days, the risk of NHS+SE, death, MI or any combined endpoints were significantly worse in both treatment arms. These data suggest that discontinuation of anticoagulant treatment with VKA or NOAC should be discouraged. HR of patients who discontinued OAC Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.

scholarly journals Long term antithrombotic treatment in atrial fibrillation patients undergoing coronary surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Skibniewski ◽  
D Venetsanos ◽  
M Janzon ◽  
L Karlsson ◽  
S Lawesson Sederholm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Public Institution ◽  
Bleeding Complications ◽  
Funding Source ◽  
Antithrombotic Treatment ◽  
Real World Data ◽  
History Of ◽  
One Year

Abstract Introduction Current revascularisation guidelines from ESC recommend treatment with oral anticoagulants (OAC) alone in atrial fibrillation (AF) patients treated with coronary artery by-pass grafting (CABG), after one year of treatment with OAC and platelet inhibition (PI). Little is known about current treatment practice and there is a paucity of evidence to guide decision making. Purpose To assess treatment patterns and clinical outcome of OAC as sole antithrombotic treatment one year after CABG in patients with a history of AF, in comparison to PI only and OAC+PI. Method We included 2 112 patients (out of 32908 who underwent isolated CABG) from 2006 to 2014 with a history of atrial fibrillation, alive one year after surgery and a CHA2DS2-VASC-score ≥2. Based on data on individual dispensed prescriptions 1 to 1.5 years after surgery, patients were assigned to one of three treatment arms: PI alone (n=931), OAC alone (n=814) or combination of OAC+PI (n=367). Differences in MACE (death, myocardial infarction [MI] and stroke) between the three groups were assessed using a Cox regression model. Data are presented as hazard ratios (HR) with 95% confidence intervals [CI], adjusted for CHA2DS2-VASC-score (which include age, sex, hypertension [HT], congestive heart failure [CHF], stroke, vascular disease and diabetes) for MACE and the individual components of MACE; and CHA2DS2-VASC+history of bleeding regarding readmission for bleeding. Median follow-up was 3 years, range (0.5–3). Results Patients treated with PI only were younger (71, 72 and 73 years) and less often had HT (62%, 72 and 70%), and CHF (30, 40 and 40%) in the PI, PI+OAC and OAC groups respectively. Patients treated with PI only, more often had a history of MI (54%) compared to OAC (42%) but not to PI+OAC (53%). The cumulative incidence of MACE at three years was 18.9, 14.0 and 14.9% in the PI, PI+OAC and OAC groups, respectively. The corresponding numbers were for death 9.9, 9.0 and 11.2%, MI 4.6, 3.5 and 1.9%, stroke 6.0, 2.7 and 2.7% and readmission for bleeding 5.9, 11.3 and 7.0%, respectively. After adjustment, PI only was associated with significantly higher risk for MACE (HR 1.36, 95% CI: 1.06–1.75), MI (HR 2.82, 95% CI: 1.47–5.40), and stroke (HR 2.34, 95% CI: 1.36–4.02); while PI+OAC was associated with higher risk for MI (HR 2.43, 95% CI: 1.09–5.34) and bleeding complications (HR 1.58, 95% CI: 1.01–2.46), compared to OAC only. Conclusions In CABG patients with a history of AF and an indication for OAC, one year after surgery, treatment with OAC alone was associated with lower MACE rate than PI alone, driven by lower rates of MI and stroke. In addition, OAC only was associated with less bleeding complications than PI+OAC. These real-world data provide support to current ESC guidelines recommending OAC alone one year after CABG surgery. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): County council of Östergötland, Sweden

Prognostic implications of supraventricular ectopy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Fredriksson ◽  
M Stridh ◽  
L Friberg ◽  
E Svennberg
Keyword(s):  
Atrial Fibrillation ◽  
County Council ◽  
Funding Source ◽  
Stockholm County ◽  
P Waves ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ectopic Beats ◽  
Supraventricular Tachycardias

Abstract Background According to consensus atrial fibrillation (AF) is an irregular heart rhythm with absence of p-waves, lasting for at least 30 seconds. However, AF is most likely a continuous disease ranging from occasional bursts of AF-like activity to permanent AF, rather than a dichotomous condition. Regardless, the 30-second AF definition leaves cardiologists without clear guidelines on how to manage patients with shorter episodes of seemingly atrial fibrillation-like activity and/or an abundance of supraventricular ectopic beats. Purpose The aim of this study was to establish the prevalence and prognostic implication of frequent supraventricular ectopic beats, isolated, in bi- or trigeminy, and supraventricular tachycardias with different characteristics. Methods In the STROKESTOP I mass-screening study for AF in 75- and 76-year olds in Sweden, 7173 participants did 30-second intermittent ECG twice daily for two weeks. ECG-recordings from STROKESTOP I were re-evaluated using an automated algorithm to detect individuals with frequent supraventricular ectopic beats or runs. Detected episodes were manually re-examined to confirm the findings. The primary endpoint was atrial fibrillation as ascertained from the nationwide Swedish Patient register. Secondary endpoints were stroke and death. Median follow-up was 4.2 (3.8–4.4) years. Results Of the 6100 examined participants 85% were free of significant supraventricular arrhythmia. Frequent supraventricular ectopic beats were the most common arrhythmia, n=709 (11.6%), and irregular SVTs were more common than regular SVTs. During follow-up 387 participants developed AF, 161 had a stroke event and there were 354 deaths. Individuals with the most AF-like SVT, irregular and lacking p-waves, n=97 (1.6%), had the highest risk of developing AF (hazard ratio 4.3 (95% confidence interval 2.7–6.8), Figure 1. They also had an increased risk of death, 2.0 (1.1–3.8). We found no significant increase in stroke risk. Conclusion Progression of atrial arrhythmias from supraventricular ectopic beats to more organized arrhythmic episodes are associated with development of AF. Extended screening for AF should be considered in individuals with frequent supraventricular activity, especially in those with supraventricular tachycardias with AF characteristics. Figure 1. Kaplan-Meier curve showing primary end-point event rate (atrial fibrillation) in participants with different arrhythmias. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by Stiftelsen Hjärtat, Boehringer Ingelheim, The Swedish Heart and Lung Association, Capio Forskningsstiftelse and Åke Wibergs Stiftelse. STROKESTOP I was founded by Stockholm County Council, the Swedish Heart & Lung Foundation, King Gustav V and Queen Victoria's Freemasons' Foundation, the Klebergska Foundation, the Tornspiran Foundation, the Scientific Council of Halland Region, the Southern Regional Healthcare Committee, the Swedish Stroke Fund, Boehringer-Ingelheim, Bayer and Pfizer. Emma Svennberg is supported by the Stockholm County Council (Clinical postdoctorial appointment) and has received research funding from the Swedish Society of Medicine.

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