scholarly journals One-year outcomes in atrial fibrillation presenting during infections: a nationwide registry-based study

2019 ◽  
Vol 41 (10) ◽  
pp. 1112-1119 ◽  
Author(s):  
Anna Gundlund ◽  
Jonas Bjerring Olesen ◽  
Jawad H Butt ◽  
Mathias Aagaard Christensen ◽  
Gunnar H Gislason ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Absolute Risk ◽  
First Year ◽  
Thromboembolic Events ◽  
Nationwide Registry ◽  
Increased Risk ◽  
Study Population ◽  
Multivariable Analyses ◽  
One Year

Abstract Aims Thromboprophylaxis guidelines for patients with concurrent atrial fibrillation (AF) during infections are unclear and not supported by data. We compared 1-year outcomes in patients with infection-related AF and infection without AF. Methods and results By crosslinking Danish nationwide registry data, AF naïve patients admitted with infection (1996–2016) were identified. Those with AF during the infection (infection-related AF) were matched 1:3 according to age, sex, type of infection, and year with patients with infection without AF. Outcomes (AF, thromboembolic events) were assessed by multivariable Cox regression. The study population comprised 30 307 patients with infection-related AF and 90 912 patients with infection without AF [median age 79 years (interquartile range 71–86), 47.6% males in both groups]. The 1-year absolute risk of AF and thromboembolic events were 36.4% and 7.6%, respectively (infection-related AF) and 1.9% and 4.4%, respectively (infection without AF). In the multivariable analyses, infection-related AF was associated with an increased long-term risk of AF and thromboembolic events compared with infection without AF: hazard ratio (HR) 25.98, 95% confidence interval (CI) 24.64–27.39 for AF and HR 2.10, 95% CI 1.98–2.22 for thromboembolic events. Further, differences in risks existed across different subtypes of infections. Conclusion During the first year after discharge, 36% of patients with infection-related AF had a new hospital contact with AF. Infection-related AF was associated with increased risk of thromboembolic events compared with infection without AF and our results suggest that AF related to infection may merit treatment and follow-up similar to that of AF not related to infection.

6116Thromboembolic risk in infection-related atrial fibrillation: is infection or atrial fibrillation the sinner?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Gundlund ◽  
J B Olesen ◽  
J H Butt ◽  
M A Christensen ◽  
G H Gislason ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Admission ◽  
Cox Regression ◽  
Anticoagulation Therapy ◽  
First Year ◽  
Thromboembolic Events ◽  
Cox Regression Analysis ◽  
Hazard Ratios ◽  
Study Population ◽  
Hospital Contact

Abstract Introduction Infection-related atrial fibrillation (AF) has been associated with similar risk of thromboembolic events as AF without a concurrent infection. However, it is unknown whether the increased thromboembolic risk in this patient group is primarily associated with AF or with the infection. Purpose We compared type of infection and 1-year outcomes in patients with AF during an infection and in patients with infection without AF. Methods By crosslinking data from Danish nationwide registries, AF naïve patients admitted with an infection from 1996–2016 were identified. Patients with infection-related AF (defined as patients who developed AF during their hospital admission with infection) were matched 1:3 on age, calendar year, sex, and type of infection (gastrointestinal infection, pneumonia, urinary tract infection, sepsis, and other infections) with those who had infection without AF. Cumulative incidences of thromboembolic events were calculated using the Aalen Johansen estimator and adjusted hazard ratios (HR) of thromboembolic events and hospital contacts with AF were assessed by multivariable Cox regression analysis comparing those with infection-related AF with those with infection without AF. Results The study population comprised 30,711 patients with infection-related AF and 92,133 patients with infection without AF (median age 79 years [interquartile range 71–86] and 47.6% males in both groups). In general, patients with infection-related AF had more concurrent diseases than patients with infection without AF. During the first week after the hospital admission, 9.8% of the patients with infection-related AF and 0.1% of the patients with infection without AF initiated oral anticoagulation therapy. During the first year after the infection, 7.6% of patients with infection-related AF and 4.4% of patients with infection without AF had a thromboembolic event, while 36.1% and 1.8% had a new hospital-contact with AF. Cumulative incidences of thromboembolic events are depicted in the Figure. In the multivariable models, infection-related AF was associated with an increased 1-year risk of thromboembolic events and new hospital contacts with AF compared with infection without AF (HR 2.05, 95% confidence interval (CI) 1.94–2.17 for thromboembolic events and HR 26.06, 95% CI 24.72–27.48 for new AF episodes, respectively). Conclusion More than one third of patients with infection-related AF had a new hospital contact with AF during the first year after their infection. Further, infection-related AF was associated with a significantly increased 1-year risk of thromboembolic events compared with infection without AF. Consequently, this study suggests that AF begets AF, even if it presents during an infection. Acknowledgement/Funding None

P4792Dabigatran versus vitamin K antagonists in patients with atrial fibrillation and valvular heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J E Strange ◽  
C Sindet-Pedersen ◽  
L Staerk ◽  
E L Grove ◽  
T A Gerds ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Vitamin K ◽  
Valvular Heart Disease ◽  
Cox Regression ◽  
Absolute Risk ◽  
Risk Difference ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background Atrial fibrillation (AF) and valvular heart disease (VHD) are both associated with an increased risk of stroke. Outside post-hoc analyses of randomized controlled trials, knowledge on the effectiveness and safety of dabigatran in patients with AF and VHD is scarce. Objectives To compare the risk of all-cause mortality, stroke, and bleeding in patients with AF and VHD treated with dabigatran or a vitamin K antagonist (VKA). Methods All Danish residents are provided a unique personal identification number enabling cross-linking of data from Danish nationwide registries. We identified all patients with AF and VHD initiating treatment with dabigatran or VKA between the 22nd of August 2011 and the 31st of December 2014. We defined VHD as aortic stenosis/regurgitation, mitral regurgitation, bioprosthetic heart valves, mitral-, and aortic valve repair. Outcomes were all-cause mortality, stroke, and bleeding. 2-year standardized absolute risks were calculated from cause-specific Cox regression models with death as competing risk. Results In total, 599 (27.3%) and 1,596 (72.7%) patients initiated treatment with dabigatran and VKA. The 2-year standardized absolute risk of all-cause mortality (95% CI) for VKA was 27.6% (25.1% to 30.1%) and 25.4% (21.8% to 29.0%) for dabigatran with a corresponding absolute risk difference of −2.2% (−6.3% to 1.9%) (Figure 1). The 2-year standardized absolute risk of stroke for VKA was 3.4% (2.3% to 4.5%) and 3.9% (2.2% to 5.5%) for dabigatran with a corresponding absolute risk difference of 0.5% (−1.6% to 2.5%). Lastly, the 2-year standardized absolute risk of bleeding for VKA was 8.2% (6.6% to 9.7%) and 7.6% (5.1% to 10.1%) for dabigatran with a corresponding absolute risk difference of −0.5% (−3.4% to 2.4%). Figure 1 Conclusions In this nationwide cohort study, we found no significant difference in the risk of all-cause mortality, stroke, or bleeding in patients with AF and VHD when comparing VKA to dabigatran.

MO503SAFETY AND EFFICACY OF ANTICOAGULATION IN PATIENTS WITH EGFR<30 ML/MIN/1.73 M2 AND ATRIAL FIBRILLATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ellen Linnea Freese Ballegaard ◽  
Jonas Bjerring Olesen ◽  
Anne Lise Kamper ◽  
Bo Feldt-Rasmussen ◽  
Gunnar Gislason ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Cox Regression ◽  
De Novo ◽  
Anticoagulation Therapy ◽  
Net Benefit ◽  
Dialysis Therapy ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
One Year

Abstract Background and Aims Net benefit of anticoagulation in patients with eGFR &lt;30 ml/min/1.73 m2 and atrial fibrillation remains uncertain. The aim of this study was to evaluate the use, efficacy and safety of anticoagulation therapy in patients with eGFR&lt;30 ml/min/1.73m2 (including dialysis treated patients) and atrial fibrillation. Method In a retrospective cohort study, all patients with atrial fibrillation and eGFR&lt;30 ml/min/1.73 m2 were identified in nationwide Danish registers between 2008 and 2018. Cumulative incidences of stroke and major bleeding stratified on anticoagulation treatment were computed using the Aalen-Johansen estimator. One-year risks of stroke and major bleeding were calculated with comparison of treatment vs. no treatment based on Cox regression models adjusted for age, sex and dialysis status with G-computation of one-year risks standardized to the distribution of risk factors in the sample. Major bleeding was defined as any diagnosis of bleeding leading to hospitalization. Results A total of 2,452 patients with eGFR &lt;30 ml/min/1.73 m2 and de novo atrial fibrillation were identified. Mean age was 78.8 years, 51.3% were male and 20% received dialysis therapy. Anticoagulation therapy was initiated in 877 patients (35.8%), with warfarin accounting for 58.6% of all prescriptions. Overall, one-year standardized risk of bleeding was 10.6% (95% confidence interval (CI) 8.7%-12.7%) and 8.2% (95% CI 6.9%-9.5%) in patients with and without anticoagulation, while the risks of stroke were 3.6% (95% CI 2.6%-4.5%) and 5.1% (95% CI 4.1%-6.1%), respectively. In subgroup analyses of patients dependent vs. non-dependent on dialysis, the standardized one-year risk of bleeding was 13.3% (95% CI 9.0%-19.8%) vs. 10.4% (95% CI 8.6%-12.4%) in patients with anticoagulation and 9.0% (95% CI 6.5%-12.0%) vs. 7.8% (95% CI 6.5%-9.2%) in patients without anticoagulation. While the risk of stroke was 3.5% (95% CI 0.8%-6.7%) vs. 3.5% (95% CI 2.5%-4.9%) in patients with anticoagulation and 5.7% (95% CI 3.5%-7.8%) vs. 4.9% (95% CI 3.7% vs. 6.3%) in patients without anticoagulation. Cumulative incidences of major bleeding and stroke are shown in the figure. Conclusion Use of anticoagulation was associated with increased risk of bleeding and reduced risk of stroke in patients with eGFR&lt;30 ml/min/1.73 m2 and atrial fibrillation. Randomized controlled trials are needed to establish the benefit and harm of anticoagulation in this population.

Oral anticoagulation among atrial fibrillation patients with anaemia: an observational cohort study

2019 ◽  
Vol 40 (46) ◽  
pp. 3782-3790 ◽  
Author(s):  
Anders Nissen Bonde ◽  
Paul Blanche ◽  
Laila Staerk ◽  
Thomas Alexander Gerds ◽  
Anna Gundlund ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Cox Regression ◽  
Absolute Risk ◽  
Vitamin K Antagonists ◽  
Severe Anaemia ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Mild Anaemia

Abstract Aims To investigate the risk of stroke/thromboembolism (TE) and major bleeding associated with anaemia among patients with atrial fibrillation (AF). Also, to assess the effects of oral anticoagulation (OAC) and time in therapeutic range (TTR) with vitamin K antagonists according to level of haemoglobin (Hb). Methods and results Through administrative registry databases, we identified all Danish patients diagnosed with AF from 1997 to 2012. We included 18 734 AF patients with recent available data on Hb. Multiple Cox regression analyses were used to estimate hazard ratios and to compute standardized absolute 1-year risks of stroke/TE and major bleeding. Among included patients, 3796 (20%) had mild anaemia (Hb 6.83–7.45 mmol/L for women and Hb 6.83–8.03 mmol/L for men) and 2562 (14%) had moderate/severe anaemia (Hb &lt;6.83 mmol/L). Moderate/severe anaemia was associated with increased risk of major bleeding and 9.1% lower median TTR compared with no anaemia. Use of OAC was associated with reduced risk of stroke/TE among patients without anaemia [standardized absolute 1-year difference −2.5%, 95% confidence interval (CI) −3.8 to −1.7%] or with mild anaemia (−2.3%, 95% CI −2.8 to −1.8%), but not with moderate/severe anaemia, (0.03%, −1.8 to +2.8%, interaction P = 0.01). Oral anticoagulation was associated with a 5.3% (95% CI 2.1–8.7%) increased standardized absolute risk of major bleeding among AF patients with moderate/severe anaemia. Conclusion Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

P4781Comparative effcomparative effectiveness and safety of factor-xa inhibitors vs phenprocoumon in patients with non-valvular atrial fibrillation and malignant diseases, insights from the RELOADED study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Bonnemeier ◽  
R Kreutz ◽  
D Enders ◽  
N Schmedt ◽  
D Haeckl ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Risk Reduction ◽  
Cox Regression ◽  
Factor Xa ◽  
Factor Xa Inhibitors ◽  
Malignant Diseases ◽  
Hazard Ratios ◽  
Increased Risk ◽  
One Year

Abstract Background Data on safety and effectiveness of Factor-Xa inhibitors and phenprocoumon in patients with non-valvular atrial fibrillation (NVAF) and malignant diseases is scarce. Among others, our study aimed to investigate the safety and effectiveness in new users of Factor-Xa inhibitors vs. phenprocoumon, the vitamin-K antagonist (VKA) of choice in Germany. Methods We conducted a new user cohort study (one year washout period) in patients with NVAF and malignant diseases. German claims data between January 1st, 2013 and June 30th, 2017 were utilized and a multiple Cox-regression was performed to calculate confounder-adjusted hazard ratios (HRs) for the risk of ischemic stroke (IS)/systemic embolism (SE), intracranial haemorrhage (ICH) as well as renal function worsening, defined by end stage renal disease (ESRD) or dialysis and acute kidney injury (AKI) in Factor-Xa inhibitors and phenprocoumon initiators. Diagnoses of malignant diseases were assessed over the one-year baseline period. Results The population comprised 3,779 phenprocoumon initiators, 3,386 rivaroxaban initiators, 2,697 apixaban initiators and 434 edoxaban initiators. In the confounder-adjusted analysis, no difference related to the risk of IS/SE was found for rivaroxaban and edoxaban vs. phenprocoumon, where apixaban showed a numerically increased risk for stroke (figure 1). Point estimates related to the risk of ICH showed the expected beneficial effects for both, rivaroxaban and apixaban. A strong beneficial effect was observed for rivaroxaban when assessing the risk of renal function worsening. Hazard ratios related to the risk of ESRD/dialysis and AKI were 0.27 (0.10; 0.69) and 0.64 (0.38; 1.06), respectively. For apixaban, only the ESRD/dialysis showed a reduction in risk when compared to phenprocoumon, HR 0.42 (0.19; 0.94). Conclusion This retrospective database study conducted in Germany adds evidence on the effectiveness and safety profile of Factor-Xa inhibitors over VKA in patients with NVAF and malignant diseases, a critical subgroup of patients where anticoagulation is challenging. However, apixaban showed a numerically increased risk for IS/SE compared to phenprocoumon. Both, rivaroxaban and apixaban showed a risk reduction for renal function worsening within the study period of 63% and 48%, respectively compared to phenprocoumon. Only rivaroxaban showed a risk reduction of 36% for AKI. Acknowledgement/Funding The study was funded by Bayer AG

scholarly journals Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. A. Salinero-Fort ◽  
F. J. San Andrés-Rebollo ◽  
J. Cárdenas-Valladolid ◽  
M. Méndez-Bailón ◽  
R. M. Chico-Moraleja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Hdl Cholesterol ◽  
First Year ◽  
Backward Elimination ◽  
One Year ◽  
Time Varying Covariates

AbstractWe aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90–1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65–85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88–6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).

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.

Abstract 13793: Role of Cardiac Autoantibodies for the Prediction of Recurrence Following Cryoballoon-based Lone Atrial Fibrillation Ablation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Muhammed U Yalcin ◽  
Kadri M Gurses ◽  
Duygu Kocyigit ◽  
Sacit A Kesikli ◽  
Hikmet Yorgun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Value ◽  
Cox Regression ◽  
Muscarinic Acetylcholine Receptor ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Lone Atrial Fibrillation ◽  
Left Atrial Volume Index ◽  
One Year ◽  
Af Recurrence

Introduction: Recent evidence have suggested that autoantibodies may play an important role in the development of atrial fibrillation (AF). Predictive value of pre-procedural autoantibodies against beta-1 adrenergic receptor (anti-β1-R) and M2-muscarinic acetylcholine receptor (anti-M2-R) for AF recurrence following cryoballoon-based pulmonary vein isolation (PVI) is still unclear. We aimed to determine the predictive value of pre-procedural anti-β1-R and anti-M2-R levels for AF recurrence in lone AF patients following cryoballoon-based PVI. METHODS: 80 patients (mean age 54.25±7.7 years; 40% males) with lone AF who underwent cryoballoon-based PVI were included in the study. Pre-procedural anti-M2-R and anti-β1-R levels were measured with ELISA. RESULTS: At one-year follow-up after ablation, late AF recurrence was observed in 17 (21.25%) patients. In the Cox regression model including number of antiarrhythmic drugs, early AF recurrence, anti-β1-R levels >159.88 ng/mL, anti-M2-R levels >277.65 ng/mL, AF duration and left atrial volume index; only anti-β1-R levels >159.88 ng/mL (HR: 4.281, p=0.039) and anti-M2-R levels >277.65 ng/mL (HR: 4.313, p=0.030) were found to be independent predictors of late AF recurrence. Anti-β1-R level >159.88 ng/mL was shown to predict late AF recurrence with a sensitivity of 70.59% and specificity of 90.48%. A cut-off value of 277.65 ng/mL for anti-M2-R level predicted AF recurrence with a sensitivity of 70.59% and specificity of 95.24%. CONCLUSION: Pre-procedural serum anti-β1-R and anti-M2-R levels are independent predictors of late AF recurrence following cryoballoon-based PVI in lone AF patients. Detection of pre-procedural anti-β1-R and anti-M2-R levels may serve as a novel method for determination of lone AF patients who may not benefit from cryoballoon-based PVI.

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