scholarly journals Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation

Stroke ◽  
2021 ◽  
Author(s):  
Jong-Ho Park ◽  
Jong-Won Chung ◽  
Oh Young Bang ◽  
Gyeong-Moon Kim ◽  
Kang-Ho Choi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Vascular Disease ◽  
Stroke Patients ◽  
Vascular Events ◽  
Atherosclerotic Burden ◽  
Artery Disease

Background and Purpose: Data on the effect on vascular outcomes of concomitant atherosclerotic vascular disease (ASVD) with atrial fibrillation (AF) after stroke are limited. This study evaluated the effect of ASVD with AF versus AF only on the risk of vascular events. Methods: We retrospectively analyzed a prospectively registered multicenter database involving 3213 stroke patients with AF. ASVD included extracranial atherosclerosis measured in the proximal portion of the internal carotid artery, intracranial atherosclerosis (all ≥50% stenosis), coronary artery disease, and peripheral artery disease and was categorized into 4 strata depending on the number of ASVDs (0, 1, 2, and 3–4). The independent associations of ASVD with major adverse cardiovascular events, stroke, and all-cause death were assessed. Results: A total of 2670 patients were included (mean age, 73.5±9.8 years; median CHA 2 DS 2 -VASc score, 5; interquartile range, 4−6). During the follow-up (mean, 1.7 years), a total of 672 (25.2%) major adverse cardiovascular events, 170 (6.4%) stroke events, and 501 (18.8%) all-cause deaths were noted. The adjusted hazard ratio for major adverse cardiovascular events versus no ASVD was 1.25 (95% CI, 1.00–1.56) for ASVD 1, 1.34 (95% CI, 1.02–1.76) for ASVD 2, and 1.93 (95% CI, 1.24–2.99) for ASVD 3–4. The adjusted hazard ratio for all-cause death versus no ASVD was 1.32 (1.01–1.74), 1.47 (1.06–2.03), and 2.39 (1.47–3.89), respectively. Among ASVD components, the presence of symptomatic or asymptomatic extracranial atherosclerosis was a more potent predictor of major adverse cardiovascular events (1.27 [1.05–1.54]) and all-cause death (1.45 [1.17–1.81]). Conclusions: ASVD burden with AF can be a cumulative marker of a high risk for untoward vascular outcomes. Among ASVD components, extracranial atherosclerosis seems to have a predominant effect.

scholarly journals Elevated Lp(a) (Lipoprotein[a]) Levels Increase Risk of 30-Day Major Adverse Cardiovascular Events in Patients Following Carotid Endarterectomy

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 2972-2982 ◽  
Author(s):  
Farahnaz Waissi ◽  
Mirthe Dekker ◽  
Nathalie Timmerman ◽  
Renate M. Hoogeveen ◽  
Joelle van Bennekom ◽  
...  
Keyword(s):  
Risk Factor ◽  
Carotid Endarterectomy ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Major Adverse Cardiovascular Events ◽  
Lipoprotein A ◽  
Kaplan Meier ◽  
Increased Risk

Background and Purpose: General population studies have shown that elevated Lp(a) (lipoprotein[a]) levels are an emerging risk factor for cardiovascular disease and subsequent cardiovascular events. The role of Lp(a) for the risk of secondary MACE in patients undergoing carotid endarterectomy (CEA) is unknown. Our objective is to assess the association of elevated Lp(a) levels with the risk of secondary MACE in patients undergoing CEA. Methods: Lp(a) concentrations were determined in preoperative blood samples of 944 consecutive patients with CEA included in the Athero-Express Biobank Study. During 3-year follow-up, major adverse cardiovascular events (MACE), consisting of myocardial infarction, stroke, and cardiovascular death, were documented. Results: After 3 years follow-up, Kaplan-Meier cumulative event rates for MACE were 15.4% in patients with high Lp(a) levels (>137 nmol/L; >80th cohort percentile) and 10.2% in patients with low Lp(a) levels (≤137 nmol/L; ≤80th cohort percentile; log-rank test: P =0.047). Cox regression analyses adjusted for conventional cardiovascular risk factors revealed a significant association between high Lp(a) levels and 3-year MACE with an adjusted hazard ratio of 1.69 (95% CI, 1.07–2.66). One-third of MACE occurred within 30 days after CEA, with an adjusted hazard ratio for the 30-day risk of MACE of 2.05 (95% CI, 1.01–4.17). Kaplan-Meier curves from time point 30 days to 3 years onward revealed no significant association between high Lp(a) levels and MACE. Lp(a) levels were not associated with histological carotid plaque characteristics. Conclusions: High Lp(a) levels (>137 nmol/L; >80th cohort percentile) are associated with an increased risk of 30-day MACE after CEA. This identifies elevated Lp(a) levels as a new potential risk factor for secondary cardiovascular events in patients after carotid surgery. Future studies are required to investigate whether Lp(a) levels might be useful in guiding treatment algorithms for carotid intervention.

scholarly journals Real-Life Incident Atrial Fibrillation in Outpatients with Coronary Artery Disease

2020 ◽  
Vol 9 (8) ◽  
pp. 2367 ◽  
Author(s):  
Sandro Ninni ◽  
Gilles Lemesle ◽  
Thibaud Meurice ◽  
Olivier Tricot ◽  
Nicolas Lamblin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Real Life ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Outpatient Visits ◽  
History Of ◽  
Artery Disease

Background: The risk, correlates, and consequences of incident atrial fibrillation (AF) in patients with chronic coronary artery disease (CAD) are largely unknown. Methods and results: We analyzed incident AF during a 3-year follow-up in 5031 CAD outpatients included in the prospective multicenter CARDIONOR registry and with no history of AF at baseline. Incident AF occurred in 266 patients (3-year cumulative incidence: 4.7% (95% confidence interval (CI): 4.1 to 5.3)). Incident AF was diagnosed during cardiology outpatient visits in 177 (66.5%) patients, 87 of whom were asymptomatic. Of note, 46 (17.3%) patients were diagnosed at time of hospitalization for heart failure, and a few patients (n = 5) at the time of ischemic stroke. Five variables were independently associated with incident AF: older age (p < 0.0001), heart failure (p = 0.003), lower left ventricle ejection fraction (p = 0.008), history of hypertension (p = 0.010), and diabetes mellitus (p = 0.033). Anticoagulant therapy was used in 245 (92%) patients and was associated with an antiplatelet drug in half (n = 122). Incident AF was a powerful predictor of all-cause (adjusted hazard ratio: 2.04; 95% CI: 1.47 to 2.83; p < 0.0001) and cardiovascular mortality (adjusted hazard ratio: 2.88; 95% CI: 1.88 to 4.43; p < 0.0001). Conclusions: In CAD outpatients, real-life incident AF occurs at a stable rate of 1.6% annually and is frequently diagnosed in asymptomatic patients during cardiology outpatient visits. Anticoagulation is used in most cases, often combined with antiplatelet therapy. Incident AF is associated with increased mortality.

Abstract 17865: The Presence of Left Ventricular Scar in Atrial Fibrillation is associated with Major Adverse Cardiovascular Events

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Promporn Suksaranjit ◽  
Nazem Akoum ◽  
Brent D Wilson ◽  
Joseph Biskupiak ◽  
Lowell Chang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Cardiovascular Events ◽  
Prognostic Significance ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
History Of ◽  
Artery Disease ◽  
Left Atrial Fibrosis

Introduction: Left ventricular (LV) scar identified by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is associated with adverse cardiovascular outcomes in patients with coronary artery disease (CAD) and cardiomyopathies. We studied the prognostic significance of LV-LGE in patients with atrial fibrillation (AF). Methods: We studied 778 consecutive patients referred for radiofrequency ablation of AF who underwent CMR exams between June 2006 and January 2013. Patients with history of CAD, prior myocardial infarction (MI), hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) were excluded (24 patients). The presence of LV-LGE was assessed by two independent observers who were blinded to the clinical data and outcomes. The endpoint of interest was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, MI and ischemic stroke. MACE was determined by systematic retrospective review of electronic medical records and ICD-9 codes. Univariate and multivariate analysis were performed to identify predictors of MACE. Results: Of the 754 patients who met the inclusion criteria, 60% were male with an average age of 64 years and 87% had LV ejection fraction ≥ 55%. LV-LGE was found in 46 (6%) patients. There were 32 MACE over the mean follow up period of 53 months. The MACE rate was 13% in AF patient with LV-LGE compared to 3.7% in patient without LV-LGE (p = 0.002). In univariable analysis, age (HR 1.05, CI 1.01-10.9, p = 0.005), prior stroke (HR 1.64, CI 1.08-2.49, p = 0.021), CHADS2 (HR 1.75, CI 1.34-2.27, p < 0.001), CHA2DS2-VASc (HR 1.32, CI 1.15-1.52, p < 0.001), left atrial fibrosis (HR 1.66, CI 1.41-1.96, p < 0.001) and LV-LGE (HR 3.68, CI 1.52-8.95, p = 0.004) were significantly associated with MACE. In multivariate analysis, age and LV-LGE were independent predictors of MACE. Conclusions: In this large cohort of AF patients, LV -LGE is shown to be an independent predictor of MACE.

Abstract 16732: Urinary 11-Dehydro-Thromboxane B2 is Associated With Vascular and Non-Vascular Events in Atrial Fibrillation Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Daniele Pastori ◽  
Pasquale Pignatelli ◽  
Roberto Cangemi ◽  
William Hiatt ◽  
Alessio Farcomeni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Events ◽  
Oral Anticoagulants ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Thromboxane B2 ◽  
Vascular Events ◽  
Residual Cardiovascular Risk ◽  
Increased Risk ◽  
Anticoagulated Patients

Introduction: Non-Valvular Atrial Fibrillation (AF) patients show high residual cardiovascular risk despite oral anticoagulants. Urinary 11-dehydro-thromboxane B2 (TxB2) is associated with an increased risk of cardiovascular events, but its predictive value in anticoagulated AF patients is unknown. Hypothesis: Aim of this was to assess whether urinary 11-dehydro-TxB2 is a predictor of cardiovascular events in anticoagulated patients with AF. Methods: Prospective single-center cohort study, including 864 consecutive AF patients. Mean time of follow-up was 30.0 months yielding 2062 person-years of observation. Urinary 11-dehydro-TxB2 was measured at baseline. The primary end-point was the composite of myocardial infarction, ischemic stroke, cardiac revascularization, cardiovascular death and deaths from any cause. Results: Cardiovascular events occurred in 98 (11.3%), whilst 81 patients died (9.4%), including 55 from cardiovascular and 26 from non-cardiovascular causes. At baseline, urinary 11-dehydro-TxB2 levels were higher in patients who experienced a cardiovascular event (p<0.001). An increased rate of cardiovascular events, cardiovascular death and all-cause death was observed across tertiles of 11-dehydro-TxB2 (p<0.001). On Cox proportional hazards analysis, CHA2DS2-VASc score, second and third tertile of 11-dehydro-TxB2, compared to the first tertile, were significant predictors of vascular and non-vascular events. On a logistic regression analysis, 11-dehydro-TxB2 levels progressively increase with increasing CHA2DS2-VASc scores. Conclusions: Urinary 11-dehydro-TxB2 predicts residual risk of cardiovascular events in anticoagulated atrial fibrillation patients. Urinary 11-dehydro-TxB2 progressively increases with increasing CHA2DS2-VASc score suggesting that anticoagulated patients with high CHA2DS2-VASc score may need additional antithrombotic strategies.

Abstract 14344: Prognostic Factors of Atrial Fibrillation Patients With Coronary Artery Disease: The Fushimi Af Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobutoyo Masunaga ◽  
Hisashi Ogawa ◽  
Yuya Aono ◽  
Syuhei Ikeda ◽  
KOSUKE DOI ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Prognostic Factors ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Cardiovascular Events ◽  
Factors Associated ◽  
Artery Disease

Background: Atrial fibrillation (AF) patients are likely to have concomitant coronary artery disease (CAD). A new strategy of antithrombotic therapy in AF patients with stable CAD was demonstrated in recent randomized clinical trials. Now that antithrombotic therapy for AF patients with CAD has reached a major turning point, it is important to know the prognostic factors in those patients. Purpose: In this study, we investigated clinical characteristics, cardiovascular events and prognostic factors in AF patients with CAD. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients who visited the participating medical institutions in Fushimi-ku, Kyoto, Japan. Follow up data including prescription status were available in 4,441 patients from March 2011 to November 2019. Of 4,441 patients, 645 patients had a history of CAD at enrollment. Results: The mean age was 76.4±8.6 and 65.9% were male. Averages of CHA 2 DS 2 -VASc score and HAS-BLED score were 4.41 and 2.35, respectively. Oral anticoagulant (OAC) was prescribed in 52.9% of those patients and antiplatelet drug (APD) was prescribed in 70.4%. The combination of OAC and APD was prescribed in 36.0%. During follow-up period (median 1,495 days), cardiac death occurred in 51 patients, composite of cardiac death, myocardial infarction (MI) and stroke in 136, and major bleeding in 77 (1.8, 5.1 and 2.9 per 100 person-years, respectively). In multivariate analysis, factors associated with composite of cardiac death, MI and stroke in AF patients with CAD were low body weight (<=50kg) (hazard ratio [95% confidence interval]; 1.62 [1.07-2.47]), previous stroke (1.69 [1.13-2.52]), heart failure (1.47 [1.02-2.11]), hypertension (0.60 [0.41-0.87]) and diabetes mellitus (1.62 [1.13-2.32]). Furthermore, factors associated with major bleeding in AF patients with CAD were anemia (male: hemoglobin<12 g/dl, female: hemoglobin<11 g/dl) (1.82 [1.09-3.04]) and thrombocytopenia (<150,000 /μL) (3.02 [1.29-7.03]). Conclusion: In Japanese AF patients with CAD, low body weight, previous stroke, heart failure, hypertension and diabetes mellitus were associated with cardiovascular events, and anemia and thrombocytopenia were associated with major bleeding.

scholarly journals Atrial Fibrillation is Associated with Femoropopliteal Totally Occlusive In-Stent Restenosis: A Single-Center, Retrospective, Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yohsuke Honda ◽  
Keisuke Hirano ◽  
Masahiro Yamawaki ◽  
Motoharu Araki ◽  
Norihiro Kobayashi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
De Novo ◽  
Limb Ischemia ◽  
Hazard Ratio ◽  
Acute Limb Ischemia ◽  
Stent Occlusion ◽  
Stent Restenosis ◽  
Artery Disease ◽  
In Stent Restenosis

Introduction. The proportion of patients with comorbid atrial fibrillation (AF) and peripheral artery disease (PAD) has increased in this era. This study aimed to assess the relationship between AF and totally occlusive in-stent restenosis (ISR) in femoropopliteal (FP) lesions. Methods. In this study, 363 patients (461 stents) who underwent endovascular therapy with de novo stent implantation in our hospital between April 2007 and December 2016 were retrospectively evaluated. The patients were divided into two groups according to the AF status (AF group, 61 patients; sinus group, 302 patients). The primary endpoint was the incidence of totally occlusive ISR within 3 years. The secondary endpoint was the incidence of acute limb ischemia (ALI) due to FP stent occlusion. Results. Baseline characteristics were similar, except for higher age and a lower prevalence of dyslipidemia in the AF group. The incidence of a totally occlusive ISR was higher in the AF group than in the sinus group (29.5% vs. 14.6%, p = 0.004 ). A multiple Cox regression model suggested that presence of AF (hazard ratio, 2.10) and CTO lesion (hazard ratio, 1.97) which were the independent predictors of a totally occlusive ISR within 3 years. The incidence of ALI was significantly higher in the AF group than in the sinus group (3.9% vs. 0%, p = 0.0001 ). In the AF group, the introduction of an anticoagulant did not prevent the occurrence of totally occlusive ISR ( p = 0.71 ) for ALI ( p = 0.79 ). Conclusions. AF is independently associated with totally occlusive ISR of FP stents; however, anticoagulant use does not prevent stent occlusion.

Clinical Outcomes in Atrial Fibrillation Patients With a History of Cancer Treated With Non-Vitamin K Antagonist Oral Anticoagulants: A Nationwide Cohort Study

Stroke ◽  
2021 ◽  
Author(s):  
Yi-Hsin Chan ◽  
Tze-Fan Chao ◽  
Hsin-Fu Lee ◽  
Shao-Wei Chen ◽  
Pei-Ru Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Propensity Score ◽  
Venous Thrombosis ◽  
Clinical Outcomes ◽  
Lower Risk ◽  
Hazard Ratio ◽  
Thrombin Inhibitor ◽  
Major Adverse Cardiovascular Events ◽  
Research Database

Background and Purpose: Data on clinical outcomes for nonvitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation and cancer are limited, and patients with active cancer were excluded from randomized trials. We investigated the effectiveness and safety for NOACs versus warfarin among patients with atrial fibrillation with cancer. Methods: In this nationwide retrospective cohort study from Taiwan National Health Insurance Research Database, we identified a total of 6274 and 1681 consecutive patients with atrial fibrillation with cancer taking NOACs and warfarin from June 1, 2012, to December 31, 2017, respectively. Propensity score stabilized weighting was used to balance covariates across study groups. Results: There were 1031, 1758, 411, and 3074 patients treated with apixaban, dabigatran, edoxaban, and rivaroxaban, respectively. After propensity score stabilized weighting, NOAC was associated with a lower risk of major adverse cardiovascular events (hazard ratio, 0.63 [95% CI, 0.50–0.80]; P =0.0001), major adverse limb events (hazard ratio, 0.41 [95% CI, 0.24–0.70]; P =0.0010), venous thrombosis (hazard ratio, 0.37 [95% CI, 0.23–0.61]; P <0.0001), and major bleeding (hazard ratio, 0.73 [95% CI, 0.56–0.94]; P =0.0171) compared with warfarin. The outcomes were consistent with either direct thrombin inhibitor (dabigatran) or factor Xa inhibitor (apixaban, edoxaban, and rivaroxaban) use, among patients with stroke history, and among patients with different type of cancer and local, regional, or metastatic stage of cancer ( P interaction >0.05). When compared with warfarin, NOAC was associated with lower risk of major adverse cardiovascular event, and venous thrombosis in patients aged <75 but not in those aged ≥75 years ( P interaction <0.05). Conclusions: Thromboprophylaxis with NOACs rather than warfarin should be considered for the majority of the atrial fibrillation population with cancer.

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