P3526Heart Failure hospitalization and mortality in non-valvular Atrial Fibrillation: The ENGAGE-AF TIMI 48 Trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R M Inciardi ◽  
R Giugliano ◽  
F Nordio ◽  
C Ruff ◽  
E Antman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Troponin I ◽  
Risk Estimation ◽  
Previous History ◽  
Factor Xa ◽  
Composite Endpoint ◽  
Heart Valve Disease ◽  
Clinical Predictors ◽  
Increased Risk ◽  
History Of

Abstract Introduction Atrial Fibrillation (AF) is associated with increased risk of cardiovascular (CV) morbidity and mortality. Heart Failure (HF) represents the most common CV complication, more common than thromboembolic events. Purpose We aimed to determine clinical factors associated with HF hospitalization and mortality in a contemporary cohort of patients with AF without previous history of HF. Methods The Effective Anticoagulation with Factor Xa Next Generation in AF–Thrombolysis in Myocardial Infarction 48 (ENGAGE-AF TIMI 48) study tested the oral factor Xa inhibitor edoxaban in comparison with warfarin for the prevention of stroke or systemic embolism, in 21,105 patients with AF. We assessed the composite endpoint of HF hospitalization, death due to HF or sudden cardiac death in 8981 patients without a history of HF. Cox proportional hazard models were used to evaluate the significant clinical predictors associated with the endpoint of interest. Results Over a median follow-up of 2.8 years, 589 patients (6.5%) experienced the composite endpoint. Older patients, cardiovascular risk factors (hypertension, diabetes, heart valve disease), history of stroke and coronary artery disease, impaired renal function (ClCr ≤50 ml/min), heart rate at baseline and diuretic use were associated with increased risk of the composite endpoint (model c-statistic 0.66) (Figure 1). Outcomes were not affected by randomization to edoxaban or warfarin. In patients with available cardiac-derived biomarkers, elevated levels of both NT-proBNP and Troponin I were significantly associated with the endpoint after adjustment for the clinical predictors (Figure 1). The addition of the biomarkers to clinical predictors enhanced risk estimation (c-statistics 0.69, NRI 0.40, IDI 0.01, all p<0.001 for NT-proBNP and c-statistics 0.70, NRI 0.43, IDI 0.03, all p<0.001 for Troponin I). Figure 1 Conclusions HF hospitalization and mortality are important complications in AF patients without a history of HF. The addition of cardiac biomarkers to clinical characteristics enhances risk estimation. These findings may improve risk stratification.

Abstract T MP104: The Role of Antithrombotics Therapy in Recent Ischaemic Stroke Patients with Atrial Fibrillation: Analysis from VISTA

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Azmil H Abdul-Rahim ◽  
Rachael L Fulton ◽  
Frank Benedikt ◽  
Turgut Tatlisumak ◽  
Maurizio Paciaroni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Recurrent Stroke ◽  
Previous History ◽  
Neurological Impairment ◽  
Antithrombotic Treatment ◽  
Risk Of Mortality ◽  
Natural Progression ◽  
Increased Risk ◽  
History Of

Background and Purpose: There is uncertainty on the optimal latency after acute ischaemic stroke at which antithrombotic treatment should commence for atrial fibrillation (AF) patients, in order to prevent recurrent stroke (RS) without provoking symptomatic intracranial haemorrhage (SICH). We sought to describe the risk factors and patterns of RS and SICH in a cohort of patients with AF and recent stroke. Methods: We assessed the association of antihrombotic treatment (i.e. anticoagulants and antiplatelets) with the distribution of the modified Rankin Scale (mRS) at day 90, and the occurrence of RS and SICH. We developed statistical models for the prediction of RS and SICH in the first 90 days after stroke, using univariate and multivariate analysis. Results: Data were available for 1,644 patients. Combined antithrombotic therapy with both anticoagulation and antiplatelet (n=782) was associated with more favourable functional outcome across full scale mRS OR=1.785 (95% CI: 1.316, 2.421; P=0.0002), and significantly lower risk of mortality by day 90, SICH by day 90 and RS by day 90: Mortality day 90 OR=0.344 (95% CI: 0.235, 0.502; P<0.0001), SICH day 90 OR=0.18 (95% CI: 0.086, 0.37; P<0.0001) and RS day 90 OR=0.33 (95% CI: 0.21, 0.53; P<0.0001). Patients with ischaemic stroke who had high baseline glucose had a high risk of both RS and SICH events after stroke. Additionally, patients who had increased neurological impairment, previous history of TIA and received no antithrombotic treatment were at increased risk of RS. The relative risk of RS versus SICH appeared constant over time. Conclusions: It seems justified to initiate anticoagulation immediately the patient attains medical and neurological stability, taking into account the potential of haemorrhagic transformation as part of the natural progression in stroke and the increasing risk of recurrent stroke with time if left untreated. Antiplatelet treatment pending introduction of anticoagulation is reasonable.

P1575Cardiovascular toxicity following modern multiple myeloma therapy in Japanese cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Shibata ◽  
S Nohara ◽  
K Nagafuji ◽  
Y Fukumoto
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Multiple Myeloma ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prior History ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
History Of

Abstract Background Multiple myeloma (MM) is a plasma cell dyscrasia accounting for approximately 13% of hematologic malignancies. Patients with MM have an increased risk of cardiovascular adverse events (CAEs) due to disease burden and/or anti-myeloma treatment-related risk factors. However, little is known about the incidence of cardiovascular toxicity of patients with MM. Methods We analyzed 42 consecutive patients (Male/Female 22/20, age 67±10 years old) who received anti-MM therapies between October 2016 and September 2018 from our University Cardio-REnal Oncology (CREO) registry. We examined the incidence of CAEs through January 2019 including congestive heart failure and cardiomyopathy (CHF/CM), ischemic cardiac event, newly symptomatic arrhythmias included atrial fibrillation or flutter requiring treatment, and venous thromboembolism (VTE). Results Within the 408-day median follow-up period (range 15–844 days), CAEs occurred in 23.8% (n=10); CHF/CM in 11.9%, newly diagnosed atrial fibrillation in 4.8%, VTE in 4.8%, vasospastic angina in 2.4%, and death in 28.6%. There were no significant differences between CAEs group and non-CAEs group in terms of sex, body mass index (BMI), incidence of hypertension, ischemic heart disease, prior history of heart failure, cardiovascular medications, left ventricular ejection fraction, serum high-sensitivity troponin-I, estimated glomerular filtration rate, blood urea nitrogen and N-terminal pro-brain natriuretic peptide levels at the time of enrollment. The use of various types of proteasome inhibitors and immunomodulatory drugs were not associated with the increased risk of CAEs. By multivariate analysis, a history of prior anti-myeloma therapies was identified as an independent risk factor for CAEs. Conclusion CAEs were significantly associated with the recurrent MM in Japanese MM patients.

P1871Bodyweight variability and atrial fibrillation development

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Lee ◽  
E K Choi ◽  
K D Han ◽  
S Oh
Keyword(s):  
Atrial Fibrillation ◽  
Weight Loss ◽  
Risk Factor ◽  
Multivariable Analysis ◽  
Previous History ◽  
Population Based ◽  
Incidence Rates ◽  
Normal Weight ◽  
Increased Risk ◽  
History Of

Abstract Background Bodyweight fluctuation is a risk factor for cardiovascular events and death. We investigated whether bodyweight variability is also a risk factor for atrial fibrillation (AF) development. Methods A nationwide population-based cohort of 8,091,401 adults from the Korean National Health Insurance Service database without previous history of AF and with at least 3 measurements of bodyweight over a 5-year period was followed up for incident AF. Intra-individual bodyweight variability was calculated using variability independent of mean, and high bodyweight variability was defined as the quartile with highest bodyweight variability (Q4) with Q1–3 as reference. Results During median 8.1 years of follow-up, AF was newly diagnosed in 158,347 (2.0%). Increasing bodyweight variability was associated with AF development after adjustment for baseline bodyweight, height, age, sex, lifestyle factors and comorbidities: each increase of 1-SD in bodyweight variability was associated with 5% increased risk of AF development (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.04–1.05), and subjects with highest bodyweight variability (Q4) showed 14% increased risk of AF development compared to those in the quartile with lowest bodyweight variability (HR 1.14, 95% CI 1.12–1.15). When the cohort was grouped by body mass index (BMI) into underweight, normal weight, overweight, obese (Figure 1A), subjects with high bodyweight variability showed a shallow U-shaped relationship of BMI with AF incidence, with the highest incidence rate of AF in the underweight group. On the other hand, subjects with reference bodyweight variability showed a proportional increase of AF incidence with BMI, with the highest AF incidence in the obese group. High bodyweight variability was significantly associated with AF development in all BMI groups except in the very obese (BMI≥30) in multivariable analysis, and this association was stronger in subjects with lower bodyweight. In underweight subjects, high bodyweight variability was associated with 16% increased risk of AF development (HR 1.16, 95% CI 1.08–1.24). Obese subjects with high bodyweight variability compared to those with reference variability showed lower crude AF incidence rates, but after multivariable analysis, AF risk was increased (obese stage I) or comparable (obese stage II). When the cohort was grouped by total bodyweight change (Figure 1B), subjects with high bodyweight variability showed higher AF incidence and elevated AF risk on multivariable analysis in all weight change groups. Subjects with overall weight loss (≥-5%) and high bodyweight variability showed the highest AF incidence and AF risk (HR 1.12, 95% CI 1.09–1.15). Figure 1 Conclusions Fluctuation in bodyweight was independently associated with higher risk of AF development. The association of high bodyweight variability with AF development was especially stronger in subjects with lower bodyweight, and in subjects with overall weight loss (≥-5%)

Abstract 17186: Left Atrial Strain Predicts Adverse Outcomes in Hypertrophic Cardiomyopathy

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Nestor Vasquez ◽  
Benjamin Ostrander ◽  
Dai-Yin Lu ◽  
Ioannis Ventoulis ◽  
Bereketeab Haileselassie ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Univariate Analysis ◽  
Composite Endpoint ◽  
Adverse Outcomes ◽  
Left Atrial Strain ◽  
Increased Risk ◽  
History Of ◽  
Atrial Strain

Introduction: Hypertrophic cardiomyopathy (HCM) patients are at increased risk for heart failure (HF), stroke, death, and paroxysmal atrial fibrillation (PAF) development. There is no consensus whether atrial fibrillation (AF) is a marker or mediator of adverse outcomes in HCM patients. Hypothesis: We hypothesized that PAF and left atrial (LA) remodeling predict adverse outcomes in HCM. Methods: Echocardiography (2D and speckle tracking) was used to assess LA size, function, and mechanics in a cohort of HCM patients with history of PAF (PAF group, n=45) and age/gender-matched HCM patients without history of AF (No-AF group; n=59). AF was diagnosed by review of EKGs, event recorder/holter monitor data, and ICD interrogation. Patients were followed for a mean of 53 months for development of the composite endpoint of HF, death, and stroke. Results: Clinical/demographic characteristics were similar in the 2 groups; 67% of PAF group had a CHADS 2 VASC score ≤ 1. The PAF group had higher LA volume, lower LA ejection fraction, and higher E/A ratio (reflecting LV diastolic dysfunction) compared to the No-AF group. LA contractile and reservoir strain/strain rate (SR) were significantly lower in the PAF group (Table 1). Male gender, LA reservoir and conduit strain/SR (not PAF presence) were associated with the development of the composite endpoint in univariate analysis. Only LA conduit and reservoir strain/SR independently predicted the composite endpoint in a multivariate model. Kaplan Meier survival analysis showed greater event-free survival among HCM patients with LA conduit strain >10.2% (Figure 1a) and LA reservoir strain >23.8% (p < 0.01) (Figure 1b). Conclusions: PAF is associated with greater degree of LA myopathy in HCM. LA myopathy assessed by conduit and reservoir strain/SR may be useful for risk stratification for HF, stroke, and death in HCM.

scholarly journals Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Hui-Ting Wang ◽  
Yung-Lung Chen ◽  
Yu-Sheng Lin ◽  
Huang-Chung Chen ◽  
Shaur-Zheng Chong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Oral Anticoagulants ◽  
Demographic Data ◽  
Previous History ◽  
Research Database ◽  
Subdistribution Hazard ◽  
Valvular Surgery ◽  
Increased Risk ◽  
History Of

Objectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This study aims to investigate whether the risk of dementia is different between AF and AFL.Methods: Patients with newly diagnosed AF and AFL during 2001–2013 were retrieved from Taiwan's National Health Insurance Research Database. Patients with incomplete demographic data, aged &lt;20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. The incidence of new-onset dementia was set as the primary outcome and analyzed in patients with AF and AFL after propensity score matching (PSM).Results: A total of 232,425 and 7,569 patients with AF and AFL, respectively, were eligible for analysis. After 4:1 PSM, we included 30,276 and 7,569 patients with AF and AFL, respectively, for analysis. Additionally, patients with AF (n = 29,187) and AFL (n = 451) who received oral anticoagulants were enrolled for comparison. The risk of dementia was higher in patients with AF compared with patients with AFL (subdistribution hazard ratio (SHR) = 1.52, 95% CI 1.39–1.66; p &lt; 0.0001) before PSM and remained higher in patients with AF (SHR = 1.14, 95% CI 1.04–1.25; p = 0.0064) after PSM. The risk of dementia was higher in patients with AF without previous history of stroke after PSM but the risk did not differ between patients with AF and AFL with previous history of stroke. Among patients who received oral anticoagulants, the cumulative incidences of dementia were significantly higher in patients with AF than in patients with AFL before and after PSM (all P &lt; 0.05).Conclusions: This study found that, among patients without history of stroke, the risk of dementia was higher in patients with AF than in patients with AFL, and CHA2DS2-VASc score might be useful for risk stratification of dementia between patients with AF and AFL.

scholarly journals An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

2021 ◽  
Vol 11 (3) ◽  
pp. 178
Author(s):  
Noah R. Delapaz ◽  
William K. Hor ◽  
Michael Gilbert ◽  
Andrew D. La ◽  
Feiran Liang ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Previous History ◽  
Current Treatment ◽  
Careful Consideration ◽  
P Value ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
History Of ◽  
Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

scholarly journals Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

2021 ◽  
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Wesley T O’Neal ◽  
J’Neka Claxton ◽  
Richard MacLehose ◽  
Lin Chen ◽  
Lindsay G Bengtson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Cox Regression ◽  
Prior History ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Increased Risk ◽  
History Of ◽  
Reduced Risk ◽  
History Of Cancer

Background: Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer. Methods: We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding. Results: A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)). Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.

684 Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Marrco Vitolo ◽  
Vincenzo Livio Malavasi ◽  
Marco Proietti ◽  
Igor Diemberger ◽  
Laurent Fauchier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of ◽  
Cardiac Troponins

Abstract Aims Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear. To assess the factors associated with cTn testing in routine clinical practice and to evaluate the association of elevated levels of cTn with adverse outcomes in a large contemporary cohort of European AF patients. Methods and results Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into three groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), and (iii) cTn elevated (&gt;99th percentile). The composite outcome of any thromboembolism/any acute coronary syndrome (ACS)/cardiovascular (CV) death, defined as major adverse cardiovascular events (MACE) and all-cause death were the main endpoints. 10 445 (94.1%) AF patients were included in this analysis [median age 71 years, interquartile range (IQR): 63–77; males 59.7%]. cTn were tested in 2834 (27.1%). Overall, cTn was elevated in 904 (8.7%) and in-range in 1930 (18.5%) patients. Patients in whom cTn was tested tended to be younger (P &lt; 0.001) and more frequently presenting with first detected AF and atypical AF-related symptoms (i.e. chest pain, dyspnoea, or syncope) (P &lt; 0.001). On multivariable logistic regression analysis, female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease (CAD), and atypical AF symptoms were independently associated with cTn testing. After a median follow-up of 730 days (IQR: 692–749), 957 (9.7%) composite endpoints occurred while all-cause death was 9.5%. Kaplan–Meier analysis showed a higher cumulative risk for both outcomes in patients with elevated cTn levels (Figure) (Log Rank tests, P &lt; 0.001). On adjusted Cox regression analysis, elevated levels of cTn were independently associated with a higher risk for MACE [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.40–2.16] and all-cause death (HR 1.45, 95% CI: 1.21–1.74). Elevated levels of cTn were independently associated with a higher occurrence of MACE, all-cause death, any ACS, CV death and hospital readmission even after the exclusion of patients with history of CAD, diagnosis of ACS at discharge, those who underwent coronary revascularization during the admission and/or who were treated with oral anticoagulants plus antiplatelet therapy. Conclusions Elevated cTn levels were independently associated with an increased risk of all-cause mortality and adverse CV events, even after exclusion of CAD patients. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

Cardiac Arrhythmia Caused by a Kirschner Wire inside the Heart

1997 ◽  
Vol 22 (3) ◽  
pp. 402-404 ◽  
Author(s):  
T. A. T. HAAPANIEMI ◽  
U. S. HERMANSSON
Keyword(s):  
Atrial Fibrillation ◽  
Thoracic Surgery ◽  
Cardiac Disease ◽  
Kirschner Wire ◽  
Previous History ◽  
Kirschner Wires ◽  
Left Hand ◽  
Plain Chest ◽  
History Of ◽  
The Right

A 45-year-old woman with no previous history of cardiac disease woke up one morning with an irregular heartbeat and fatigue. An electrocardiogram showed atrial fibrillation and plain chest radiographs revealed the presence of a metallic pin at the position of the heart. A 24 mm-long metallic pin was removed by open thoracic surgery from within the right ventricle of the heart. Postoperative examination of the pin showed it to be one of the 0.8 mm Kirschner wires that had been used for finger osteosynthesis in her left hand 31 months previously.

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