Predictors of Early and Late Infarct Growth in DEFUSE 3

Introduction: The goal of this study is to explore the impact of reperfusion and collateral status on infarct growth in the early and late time windows.Materials and Methods: Seventy patients from the DEFUSE 3 trial (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) with baseline, 24-h, and late follow-up scans were evaluated. Scans were taken with DWI or CTP at time of enrollment (Baseline), with DWI or CT 24-h after enrollment (24-h), and with DWI or CT 5 days after enrollment (Late). Early infarct growth (between baseline and 24-h scans) and late infarct growth (between 24-h and late scans) was assessed for each patient. The impact of collateral and reperfusion status on infarct growth was assessed in univariate and multivariate regression.Results: The median early infarct growth was 30.3 ml (IQR 16.4–74.5) and the median late infarct growth was 6.7 ml (IQR −3.5–21.6) in the overall sample. Patients with poor collaterals showed greater early infarct growth (Median 58.5 ml; IQR 18.6–125.6) compared to patients with good collaterals (Median 28.4 ml; IQR 15.8–49.3, unadjusted p = 0.04, adjusted p = 0.06) but showed no difference in late infarct growth. In contrast, patients who reperfused showed no reduction in early infarct growth but showed reduced late infarct growth (Median 1.9 ml; IQR −6.1–8.5) compared to patients without reperfusion (Median 11.2 ml; IQR −1.1–27.2, unadjusted p < 0.01, adjusted p = 0.04).Discussion: In the DEFUSE 3 population, poor collaterals predict early infarct growth and absence of reperfusion predicts late infarct growth. These results highlight the need for timely reperfusion therapy, particularly in patients with poor collaterals and indicate that the 24-h timepoint is too early to assess the full impact of reperfusion therapy on infarct growth.Clinical Trial Registration:http://www.clinicaltrials.gov, Unique identifier [NCT02586415].

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Evolution of Hypodensity on Non-Contrast CT in Correlation with Collaterals in Anterior Circulation Stroke with Successful Endovascular Reperfusion

Journal of Clinical Medicine ◽

10.3390/jcm11020446 ◽

2022 ◽

Vol 11 (2) ◽

pp. 446

Author(s):

Michał Gębka ◽

Anna Bajer-Czajkowska ◽

Sandra Pyza ◽

Krzysztof Safranow ◽

Wojciech Poncyljusz ◽

...

Keyword(s):

Time Window ◽

Time Windows ◽

Volume Ratio ◽

Significant Negative Correlation ◽

Artery Occlusion ◽

Late Time ◽

Anterior Circulation ◽

Contrast Ct ◽

The Impact

Introduction: The aim of the study was to assess the impact of collaterals on the evolution of hypodensity on non-contrast CT (NCCT) in anterior circulation stroke with reperfusion by mechanical thrombectomy (MT). Methods: We retrospectively included stroke patients with middle cerebral artery occlusion who were reperfused by MT in early and late time window. Artificial intelligence (AI)-based software was used to calculate of hypodensity volumes at baseline NCCT (V1) and at follow-up NCCT 24 h after MT (V2), along with the difference between the two volumes (V2-V1) and the follow-up (V2)/baseline (V1) volume ratio (V2/V1). The same software was used to classify collateral status by using a 4-point scale where the score of zero indicated no collaterals and the score of three represented contrast filling of all collaterals. The volumetric values were correlated with the collateral scores. Results: Collateral scores had significant negative correlation with V1 (p = 0.035), V2, V2− V1 and V2/V1 (p < 0.001). In cases with collateral score = 3, V2 was significantly smaller or absent compared to V1; in those with collateral score 2, V2 was slightly larger than V1, and in those with scores 1 and 0 V2 was significantly larger than V1. These relationships were observed in both early and late time windows. Conclusions: The collateral status determined the evolution of the baseline hypodensity on NCCT in patients with anterior circulation stroke who had MT reperfusion. Damage can be stable or reversible in patients with good collaterals while in those with poor collaterals tissues that initially appear normal will frequently appear as necrotic after 24 h. With good collaterals, it is stable or can be reversible while with poor collaterals, normal looking tissue frequently appears as necrotic in follow-up exam. Hence, acute hypodensity represents different states of the ischemic brain parenchyma.

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Incidence and Predictors of Hospitalization in Patients with Atrial Fibrillation: Results from the Chinese Atrial Fibrillation Registry Study

10.21203/rs.3.rs-123416/v1 ◽

2020 ◽

Author(s):

Zhaojie Dong ◽

Xin Du ◽

Shangxin Lu ◽

Chao Jiang ◽

Shijun Xia ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Diseases ◽

Proportional Hazards Model ◽

Cox Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Chronic Obstructive ◽

Unique Identifier ◽

Clinical Trial Registration

Abstract Background: Patients with atrial fibrillation (AF) underwent a high risk of hospitalization, which, however, has not been paid much attention in clinic. Therefore, we aimed to assess the incidence, causes and predictors of hospitalization in AF patients.Methods: From August 2011 to December 2017, 20,172 AF patients from the Chinese Atrial Fibrillation Registry (China-AF) Study were enrolled in this study. We described the incidence, causes of hospitalization according to age and gender categories. The Cox proportional hazards model was employed to identify predictors of first all-cause and first cause-specific hospitalization. Results: After a mean follow-up of 37.3 ± 20.4 months, 7,512 (37.2%) AF patients experienced one or more hospitalizations. The overall incidence of all-cause hospitalization was 24.0 per 100 patient-years. Patients aged < 65 years were predominantly hospitalized for AF (42.1% of the total frequency of hospitalizations); while patients aged 65-74 and ≥ 75 years were mainly hospitalized for non-cardiovascular diseases (43.6% and 49.3%, respectively). Multivariate Cox model analysis verified the higher risk of hospitalization in patients complicated with heart failure (HF)[hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.08-1.24], established coronary artery disease (CAD) (HR 1.26, 95%CI 1.19-1.34), ischemic stroke/transient ischemic attack (TIA) (HR 1.26, 95%CI 1.18-1.33), diabetes (HR 1.16, 95%CI 1.10-1.22), chronic obstructive pulmonary disease (COPD) (HR 1.41, 95%CI 1.13-1.76), gastrointestinal disorder (HR 1.39, 95%CI 1.23-1.58), and renal dysfunction (HR 1.31, 95%CI 1.16-1.48). Conclusions: More than one-third of AF patients included in this study were hospitalized at least once during almost 3 years of follow-up. The main cause for hospitalization among elderly patients (≥65 years) is non-cardiovascular diseases rather than AF. Multidisciplinary management of comorbidities should be advocated as strategies to reduce hospitalization in AF patients.Clinical Trial Registration: URL: http://www.chictr.org.cn/showproj.aspx?proj=5831. Unique identifier: ChiCTR-OCH-13003729.

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Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis

Circulation ◽

10.1161/circulationaha.119.041949 ◽

2019 ◽

Vol 140 (18) ◽

pp. 1451-1459 ◽

Cited By ~ 10

Author(s):

John W. Eikelboom ◽

Stuart J. Connolly ◽

Jacqueline Bosch ◽

Olga Shestakovska ◽

Victor Aboyans ◽

...

Keyword(s):

Clinical Trial ◽

Gastrointestinal Bleeding ◽

Cancer Diagnosis ◽

Minor Bleeding ◽

Antithrombotic Drugs ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Risk Of Bleeding ◽

Genitourinary Cancer

Background: Patients treated with antithrombotic drugs are at risk of bleeding. Bleeding may be the first manifestation of underlying cancer. Methods: We examined new cancers diagnosed in relation to gastrointestinal or genitourinary bleeding among patients enrolled in the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) and determined the hazard of new cancer diagnosis after bleeding at these sites. Results: Of 27 395 patients enrolled (mean age, 68 years; women, 21%), 2678 (9.8%) experienced any (major or minor) bleeding, 713 (2.6%) experienced major bleeding, and 1084 (4.0%) were diagnosed with cancer during a mean follow-up of 23 months. Among 2678 who experienced bleeding, 257 (9.9%) were subsequently diagnosed with cancer. Gastrointestinal bleeding was associated with a 20-fold higher hazard of new gastrointestinal cancer diagnosis (7.4% versus 0.5%; hazard ratio [HR], 20.6 [95% CI, 15.2–27.8]) and 1.7-fold higher hazard of new nongastrointestinal cancer diagnosis (3.8% versus 3.1%; HR, 1.70 [95% CI, 1.20–2.40]). Genitourinary bleeding was associated with a 32-fold higher hazard of new genitourinary cancer diagnosis (15.8% versus 0.8%; HR, 32.5 [95% CI, 24.7–42.9]), and urinary bleeding was associated with a 98-fold higher hazard of new urinary cancer diagnosis (14.2% versus 0.2%; HR, 98.5; 95% CI, 68.0–142.7). Nongastrointestinal, nongenitourinary bleeding was associated with a 3-fold higher hazard of nongastrointestinal, nongenitourinary cancers (4.4% versus 1.9%; HR, 3.02 [95% CI, 2.32–3.91]). Conclusions: In patients with atherosclerosis treated with antithrombotic drugs, any gastrointestinal or genitourinary bleeding was associated with higher rates of new cancer diagnosis. Any gastrointestinal or genitourinary bleeding should prompt investigation for cancers at these sites. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01776424.

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Cardiac and Kidney Benefits of Empagliflozin in Heart Failure Across the Spectrum of Kidney Function: Insights from the EMPEROR-Reduced Trial

Circulation ◽

10.1161/circulationaha.120.051685 ◽

2020 ◽

Cited By ~ 2

Author(s):

Faiez Zannad ◽

João Pedro Ferreira ◽

Stuart J. Pocock ◽

Cordula Zeller ◽

Stefan D. Anker ◽

...

Keyword(s):

Kidney Function ◽

Primary Outcome ◽

Cardiovascular Death ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Reduced Ejection Fraction ◽

Secondary Outcomes ◽

Kidney Impairment ◽

Kidney Function Decline

Background: In EMPEROR-Reduced, empagliflozin reduced cardiovascular death or HF hospitalization, total HF hospitalizations, and slowed the progressive decline in kidney function in patients with HF and a reduced ejection fraction (HFrEF), with and without diabetes. We aim to study the effect of empagliflozin on cardiovascular and kidney outcomes across the spectrum of kidney function. Methods: In this pre-specified analysis, patients were categorized by the presence or absence of CKD at baseline (eGFR<60ml/min/1.73m 2 or UACR>300mg/g). The primary and key secondary outcomes were (1) a composite of cardiovascular death or HF hospitalization (primary outcome); (2) total HF hospitalizations, and (3) eGFR slope. The direct impact on kidney events was investigated by a prespecified composite kidney outcome (defined as a sustained profound decline in eGFR, chronic dialysis or transplant). The median follow-up was 16 months. Results: 3730 patients were randomized to empagliflozin or placebo, of whom 1978 (53%) had CKD. Empagliflozin reduced the primary outcome and total HF hospitalizations in patients with and without CKD: primary outcome HR=0.78 (95%CI=0.65-0.93) and HR=0.72 (95%CI=0.58-0.90), respectively; interaction P=0.63. Empagliflozin slowed the slope of eGFR decline by 1.11 (0.23-1.98) ml/min/1.73m 2 /year in patients with CKD and by 2.41 (1.49-3.32) ml/min/1.73m2/year in patients without CKD. The risk of the composite kidney outcome was reduced similarly in patients with and without CKD: HR=0.53 (95%CI=0.31-0.91) and HR=0.46 (95%CI=0.22-0.99), respectively. The effect of empagliflozin on the primary composite outcome and the key secondary outcomes was consistent across a broad range of baseline kidney function, measured by clinically relevant eGFR subgroups or by albuminuria, including patients with eGFR as low as 20 ml/min/1.73m 2 . Empagliflozin was well tolerated in CKD patients. Conclusions: In EMPEROR-reduced, empagliflozin had a beneficial effect on the key efficacy outcomes and slowed the rate of kidney function decline in patients with and without CKD and regardless of the severity of kidney impairment at baseline. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03057977

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Impact of empagliflozin on right ventricular parameters and function among patients with type 2 diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-021-01390-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Bradley Sarak ◽

Subodh Verma ◽

C. David Mazer ◽

Hwee Teoh ◽

Adrian Quan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Right Ventricular ◽

Left Ventricular ◽

Volume Index ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Sglt2 Inhibition ◽

And Function ◽

The Impact

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibition reduces cardiovascular events in type 2 diabetes (T2DM) and is associated with a reduction in left ventricular (LV) mass index. However, the impact on right ventricular (RV) remodeling is unknown. Accordingly, the objective of this study was to assess the impact of SGLT2 inhibition on RV parameters and function in T2DM and coronary artery disease (CAD). Methods In EMPA-HEART CardioLink-6, 97 patients with T2DM and CAD were randomly assigned to empagliflozin 10 mg (n = 49) once daily or placebo (n = 48). Cardiac magnetic resonance imaging was performed at baseline and after 6 months. RV mass index (RVMi), RV end-diastolic and end-systolic volume index (RVEDVi, RVESVi) and RV ejection fraction (RVEF) were assessed in blinded fashion. Results At baseline, mean RVMi (± SD) (11.8 ± 2.4 g/m2), RVEF (53.5 ± 4.8%), RVEDVi (64.3 ± 13.2 mL/m2) and RVESVi (29.9 ± 6.9 mL/m2) were within normal limits and were similar between the empagliflozin and placebo groups. Over 6 months, there were no significant differences in RVMi (− 0.11 g/m2, [95% CI − 0.81 to 0.60], p = 0.76), RVEF (0.54%, [95% CI − 1.4 to 2.4], p = 0.58), RVEDVi (− 1.2 mL/m2, [95% CI − 4.1 to 1.7], p = 0.41) and RVESVi (− 0.81 mL/m2, [95% CI − 2.5 to 0.90], p = 0.35) in the empaglifozin group as compared with the placebo group. In both groups, there was no significant correlation between RVMi and LVMi changes from baseline to 6 months. Conclusions In this post-hoc analysis, SGLT2 inhibition with empagliflozin had no impact on RVMi and RV volumes in patients with T2DM and CAD. The potentially differential effect of empagliflozin on the LV and RV warrants further investigation. Clinical Trial Registration: URL: https://www.clinicaltrials.gov/ct2/show/NCT02998970?cond=NCT02998970&draw=2&rank=1. Unique identifier: NCT02998970.

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Abstract WP57: Acute Carotid Stenting Following Intracranial Thrombectomy Has Comparable Safety and Efficacy in Early versus Late Time Window Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp57 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Amer Mitchelle ◽

Fiona S Lau ◽

Andrew Cheung ◽

Jason Wenderoth ◽

Alexander McQuinn ◽

...

Keyword(s):

Symptom Onset ◽

Time Window ◽

Time Windows ◽

Early Time ◽

Carotid Stenting ◽

Late Time ◽

Extracranial Internal Carotid Artery ◽

Anterior Circulation ◽

Endovascular Thrombectomy

Introduction: Endovascular thrombectomy (EVT) is beneficial in late time window stroke. However, patients with tandem extracranial carotid and intracranial occlusions are under-represented in previous trials. We analysed our acute anterior circulation strokes with tandem occlusions treated with EVT and extracranial internal carotid artery stenting. Methods: A prospectively maintained database of EVT patients treated in two Australian comprehensive stroke centres between January 2016 and May 2019 was screened for acute anterior circulation ischaemic stroke patients treated with EVT and extracranial internal carotid artery stenting. The cohort was divided into patients treated in early ( < 6 hours from symptom onset) and late (>6 hours from symptom onset) time windows. Results: Endovascular thrombectomy with acute carotid stenting was performed in 96 patients (mean age 71years, 78.3% male, mean time to reperfusion 13.5 +/- 10.1 hours, median NIHSS 15). Treatment >6hours after symptom onset occurred in 61 (63.5%) patients. No significant difference was seen between the two groups with respect to age, sex, presenting NIHSS, or mTICI score. At 90-day follow-up, good functional outcome (mRS 0-2) was similar for patients treated in the late versus early time windows, 19 (54.3%) vs 34 (55.7%), p=0.89 respectively. No difference was seen for symptomatic intracranial haemorrhage, 5 (7.2%) vs 3 (8.1%) p=0.87, or mortality at 90-day follow-up, 15 (24.6%) vs 6 (17.1%) p=0.40. Conclusion: Carotid stenting in late time window has comparable safety and efficacy to early time window stroke.

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The Infarct Core is Well Represented by the Acute Diffusion Lesion: Sustained Reversal is Infrequent

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2011.102 ◽

2011 ◽

Vol 32 (1) ◽

pp. 50-56 ◽

Cited By ~ 121

Author(s):

Bruce CV Campbell ◽

Archana Purushotham ◽

Soren Christensen ◽

Patricia M Desmond ◽

Yoshinari Nagakane ◽

...

Keyword(s):

Normal Brain ◽

Lesion Volume ◽

Infarct Core ◽

Imaging Evaluation ◽

Echoplanar Imaging ◽

Median Volume ◽

Stroke Evolution ◽

Evaluation Trial ◽

The Impact

Diffusion-weighted imaging (DWI) is commonly used to assess irreversibly infarcted tissue but its accuracy is challenged by reports of diffusion lesion reversal (DLR). We investigated the frequency and implications for mismatch classification of DLR using imaging from the EPITHET (Echoplanar Imaging Thrombolytic Evaluation Trial) and DEFUSE (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution) studies. In 119 patients (83 treated with IV tissue plasminogen activator), follow-up images were coregistered to acute diffusion images and the lesions manually outlined to their maximal visual extent in diffusion space. Diffusion lesion reversal was defined as voxels of acute diffusion lesion that corresponded to normal brain at follow-up (i.e., final infarct, leukoaraiosis, and cerebrospinal fluid (CSF) voxels were excluded from consideration). The appearance of DLR was visually checked for artifacts, the volume calculated, and the impact of adjusting baseline diffusion lesion volume for DLR volume on perfusion-diffusion mismatch analyzed. Median DLR volume reduced from 4.4 to 1.5 mL after excluding CSF/leukoaraiosis. Visual inspection verified 8/119 (6.7%) with true DLR, median volume 2.33 mL. Subtracting DLR from acute diffusion volume altered perfusion—diffusion mismatch ( Tmax>6 seconds, ratio>1.2) in 3/119 (2.5%) patients. Diffusion lesion reversal between baseline and 3 to 6 hours DWI was also uncommon (7/65, 11%) and often transient. Clinically relevant DLR is uncommon and rarely alters perfusion—diffusion mismatch. The acute diffusion lesion is generally a reliable signature of the infarct core.

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Factors associated with headache and neck pain among telecommuters – a five days follow-up

BMC Public Health ◽

10.1186/s12889-021-11144-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mariève Houle ◽

Arianne Lessard ◽

Émile Marineau-Bélanger ◽

Arnaud Lardon ◽

Andrée-Anne Marchand ◽

...

Keyword(s):

Risk Factors ◽

Neck Pain ◽

Multivariate Regression ◽

Associated Factors ◽

Multivariate Regression Model ◽

Work Related ◽

Related Risk ◽

The Impact ◽

Headache And Neck Pain

Abstract Background The current sanitary crisis brought on by the COVID-19 recently forced a large proportion of workers to adopt telecommuting with limited time to plan transition. Given that several work-related risk factors are associated with headache and neck pain, it seems important to determine those associated with headache and neck pain in telecommuters. The main objective of this study was to identify which telecommuting and individual associated factors are related with headache and neck pain occurrence in telecommuters over a five days follow-up. The second objective was to evaluate the impact of wearing a headset on headache and neck pain intensity in telecommuters. Methods One hundred and sixty-two participants in telecommuting situation were recruited. Baseline assessment included sociodemographic data, headache and neck pain-related disability (6-item Headache Impact Test (HIT-6) and Neck Bournemouth Questionnaire (NBQ)), headache and neck pain frequency and intensity as well as questions about the wearing of a headset (headset wearing, headset type and headset wearing hours). A prospective data collection of headache, neck pain and headset wearing was conducted using daily e-mail over a 5-day follow-up. A stepwise multivariate regression model was performed to determine associated factors of headache or neck pain occurrence during the follow-up. A t-test was conducted to assess the impact of headset wearing on headache and neck pain intensity during the follow-up. Results Regarding headache, the stepwise multivariate regression model showed that the HIT-6 score was associated with future headache occurrence in telecommuters (OR (95% CI) = 1.094 (1.042–1.148); R2 = 0.094; p < 0.001). For neck pain, the stepwise multivariate regression showed that the NBQ score was related to future neck pain occurrence in telecommuters (OR (95% CI) = 1.182 (1.102–1.269); R2 = 0.182; p < 0.001). T-test showed no difference between participants that wore a headset and participant that did not wore a headset on mean headache (p = 0.94) and neck pain (p = 0.56) intensity during the five days follow-up. Conclusion Although several work-related risk factors are associated with headache and neck pain in workers, telecommuting did not present the same risks. Working set-up did not have a significant impact on headache and neck pain as headache-related disability was the only associated factor of future headache episodes and neck-pain related disability was the only associated factor of future neck pain episodes. Also, wearing a headset had no impact on headache and neck pain in telecommuters.

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Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure: The COAPT Trial

Circulation ◽

10.1161/circulationaha.120.053061 ◽

2021 ◽

Author(s):

Saibal Kar ◽

Michael J. Mack ◽

JoAnn Lindenfeld ◽

William T. Abraham ◽

Federico M. Asch ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Mitral Regurgitation ◽

Life Outcomes ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Medical Treatments ◽

Transcatheter Mitral Valve Repair

Background: In the randomized COAPT trial, among 614 heart failure (HF) patients with 3+ or 4+ secondary mitral regurgitation (MR), transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR, HF hospitalizations (HFH), and mortality and improved quality of life compared with guideline-directed medical therapy (GDMT) alone. We sought to examine the prognostic relationship between MR reduction and outcomes after TMVr and GDMT alone. Methods: Outcomes in COAPT between 30 days and 2 years were examined based on the severity of residual MR at 30 days. Results: TMVr-treated patients had less severe residual MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%, 19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively, P<0.0001). The rate of composite death or HFH between 30 days and 2 years was lower in patients with 30-day residual MR of 0/1+ and 2+ compared with 3+/4+ (37.7% versus 49.5% versus 72.2%, respectively, P<0.0001). This relationship was consistent in the TMVr and GDMT arms (P interaction =0.92). The improvement in KCCQ score from baseline to 30 days was maintained between 30 days and 2 years in patients with 30-day MR ≤2+ but deteriorated in those with 30-day MR 3+/4+ (-0.3±1.7 versus -9.4±4.6, P=0.0008) consistently in both groups (P interaction =0.95). Conclusions: In the COAPT trial, reduced MR at 30 days was associated with greater freedom from death or HFH and improved quality of life through 2-year follow-up whether the MR reduction was achieved by TMVr or GDMT. Clinical Trial Registration: https://www.clinicaltrials.gov Unique Identifier: NCT01626079

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The association between patterns of atrial fibrillation, anticoagulation, and cardiovascular events

EP Europace ◽

10.1093/europace/euz292 ◽

2019 ◽

Vol 22 (2) ◽

pp. 195-204 ◽

Cited By ~ 4

Author(s):

Dan Atar ◽

Eivind Berge ◽

Jean-Yves Le Heuzey ◽

Saverio Virdone ◽

A John Camm ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Events ◽

Cox Regression ◽

Risk Calculator ◽

Systemic Embolism ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Risk Of Death ◽

Anticoagulated Patients

Abstract Aims Guidelines do not recommend to take pattern of atrial fibrillation (AF) into account for the indication of anticoagulation (AC). We assessed AF pattern and the risk of cardiovascular events during 2-years of follow-up. Methods and results We categorized AF as paroxysmal, persistent, or permanent in 29 181 patients enrolled (2010–15) in the Global Anticoagulant Registry In the FIELD of AF (GARFIELD-AF). We used multivariable Cox regression to assess the risks of stroke/systemic embolism (SE) and death across patterns of AF, and whether this changed with AC on outcomes. Atrial fibrillation pattern was paroxysmal in 14 344 (49.2%), persistent in 8064 (27.6%), and permanent 6773 (23.2%) patients. Median CHA2DS2-VASc, GARFIELD-AF, and HAS-BLED scores assessing the risk of stroke/SE and/or bleeding were similar across AF patterns, but the risk of death, as assessed by the GARFIELD-AF risk calculator, was higher in non-paroxysmal than in paroxysmal AF patterns. During 2-year follow-up, after adjustment, non-paroxysmal AF patterns were associated with significantly higher rates of all-cause death, stroke/SE, and new/worsening congestive heart failure (CHF) than paroxysmal AF in non-anticoagulated patients only. In anticoagulated patients, a significantly higher risk of death but not of stroke/SE and new/worsening CHF persisted in non-paroxysmal compared with paroxysmal AF patterns. Conclusion In non-anticoagulated patients, non-paroxysmal AF patterns were associated with higher risks of stroke/SE, new/worsening HF and death than paroxysmal AF. In anticoagulated patients, the risk of stroke/SE and new/worsening HF was similar across all AF patterns. Thus AF pattern is no longer prognostic for stroke/SE when patients are treated with anticoagulants. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

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