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Verburg A, Bor WL, Küçük IT, Henriques JPS, Vink MA, Ruifrok WPT, Plomp J, Heestermans TACM, Schotborgh CE, Vlaar PJ, Magro M, Rikken SAOF, van den Broek WWA, van Mieghem CAG, Cornelis K, Rosseel L, Dujardin KS, Vandeloo B, Vandendriessche T, Ferdinande B, van 't Hof AWJ, Tijssen JGP, Limbruno U, De Caterina R, Rubboli A, Angiolillo DJ, Adriaenssens T, Dewilde W, Ten Berg JM. Temporary omission of oral anticoagulation in atrial fibrillation patients undergoing percutaneous coronary intervention: rationale and design of the WOEST-3 randomised trial. EUROINTERVENTION 2024; 20:e898-e904. [PMID: 39007830 PMCID: PMC11228535 DOI: 10.4244/eij-d-24-00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/22/2024] [Indexed: 07/16/2024]
Abstract
The optimal antithrombotic management of atrial fibrillation (AF) patients who require oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) remains unclear. Current guidelines recommend dual antithrombotic therapy (DAT; OAC plus P2Y12 inhibitor - preferably clopidogrel) after a short course of triple antithrombotic therapy (TAT; DAT plus aspirin). Although DAT reduces bleeding risk compared to TAT, this is counterbalanced by an increase in ischaemic events. Aspirin provides early ischaemic benefit, but TAT is associated with an increased haemorrhagic burden; therefore, we propose a 30-day dual antiplatelet therapy (DAPT; aspirin plus P2Y12 inhibitor) strategy post-PCI, temporarily omitting OAC. The study aims to compare bleeding and ischaemic risk between a 30-day DAPT strategy following PCI and a guideline-directed therapy in AF patients requiring OAC. WOEST-3 (ClinicalTrials.gov: NCT04436978) is an investigator-initiated, international, open-label, randomised controlled trial (RCT). AF patients requiring OAC who have undergone successful PCI will be randomised within 72 hours after PCI to guideline-directed therapy (edoxaban plus P2Y12 inhibitor plus limited duration of aspirin) or a 30-day DAPT strategy (P2Y12 inhibitor plus aspirin, immediately discontinuing OAC) followed by DAT (edoxaban plus P2Y12 inhibitor). With a sample size of 2,000 patients, this trial is powered to assess both superiority for major or clinically relevant non-major bleeding and non-inferiority for a composite of all-cause death, myocardial infarction, stroke, systemic embolism or stent thrombosis. In summary, the WOEST-3 trial is the first RCT temporarily omitting OAC in AF patients, comparing a 30-day DAPT strategy with guideline-directed therapy post-PCI to reduce bleeding events without hampering efficacy.
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Affiliation(s)
- Ashley Verburg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Wilbert L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - I Tarik Küçük
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten A Vink
- Department of Cardiology, OLVG, Amsterdam, the Netherlands
| | | | - Jacobus Plomp
- Department of Cardiology, Tergooi MC, Blaricum, the Netherlands
| | | | | | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Michael Magro
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Sem A O F Rikken
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | | | | | | | - Liesbeth Rosseel
- Department of Cardiology, Algemeen Stedelijk Hospital, Aalst, Belgium
| | | | - Bert Vandeloo
- Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | | | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Arnoud W J van 't Hof
- Department of Cardiology, University Medical Centre Maastricht, Maastricht, the Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Jan G P Tijssen
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ugo Limbruno
- Cardioneurovascular Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Raffaele De Caterina
- Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy and University of Pisa, Pisa, Italy
- Fondazione Villaserena per la Ricerca, Città Sant'Angelo, Italy
| | - Andrea Rubboli
- Department of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Tom Adriaenssens
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Willem Dewilde
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, University Medical Centre Maastricht, Maastricht, the Netherlands
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2
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Gerçek M, Börgermann J, Gummert J, Gerçek M. Postoperative Atrial Fibrillation Prediction by Left Atrial Size in Coronary Artery Bypass Grafting and Five-Year Survival Outcome. J Clin Med 2024; 13:3738. [PMID: 38999309 PMCID: PMC11242862 DOI: 10.3390/jcm13133738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Postoperative Atrial Fibrillation (POAF) is a common complication in cardiac surgery. Despite its multifactorial origin, the left atrial (LA) size is closely linked to POAF, raising the question of a valid cut-off value and its impact on the long-term outcome. Methods: Patients without a history of AF who underwent coronary artery bypass grafting between 2014 and 2016 were selected for this retrospective study. LA size was preoperatively assessed using the left atrial anterior-posterior diameter (LAAPd). Correlation and logistic regression analyses were performed, following a receiver-operating characteristic (ROC) analysis. Propensity score matching (PSM) was applied to ensure group comparability, followed by a comparison analysis regarding the primary endpoint of POAF and the secondary endpoints of all-cause mortality and stroke during a five-year follow-up. Results: A total of 933 patients were enrolled in the study eventually revealing a significant correlation between LAAPd and POAF (cor = 0.09, p < 0.01). A cut-off point of 38.5 mm was identified, resulting in groups with 366 patients each after PSM. Overall, patients with a dilated LA presented a significantly higher rate of POAF (22.3% vs. 30.4%, p = 0.02). In a five-year follow-up, a slightly higher rate of all-cause mortality (9.8% vs. 13.7%, HR 1.4 [0.92-2.29], p = 0.10) was observed, but there was no difference in the occurrence of strokes (3.6% vs. 3.3%, p = 0.87). Conclusions: An LAAPd of >38.5 mm was found to be an independent predictor of POAF after coronary artery bypass grafting and resulted in a non-significant tendency towards a worse outcome regarding all-cause mortality in a five-year follow-up.
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Affiliation(s)
- Mustafa Gerçek
- Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Gerrickstraße 21, 47137 Duisburg, Germany; (M.G.); (J.B.)
| | - Jochen Börgermann
- Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Gerrickstraße 21, 47137 Duisburg, Germany; (M.G.); (J.B.)
| | - Jan Gummert
- Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, NRW, Ruhr-Universität Bochum, Medizinische Fakultät OWL (Universität Bielefeld), Georgstraße 11, 32545 Bad Oeynhausen, Germany;
| | - Muhammed Gerçek
- Herz- und Diabeteszentrum NRW, Clinic for General and Interventional Cardiology/Angiology, NRW, Ruhr-Universität Bochum, Medizinische Fakultät OWL (Universität Bielefeld), Georgstraße 11, 32545 Bad Oeynhausen, Germany
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3
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Luo J, Li Z, Qin X, Zhang X, Liu X, Zhang W, Xu W, Liu B, Wei Y. Association of stress hyperglycemia ratio with in-hospital new-onset atrial fibrillation and long-term outcomes in patients with acute myocardial infarction. Diabetes Metab Res Rev 2024; 40:e3726. [PMID: 37712510 DOI: 10.1002/dmrr.3726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/14/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
AIMS To investigate the predictive value and prognostic impact of stress hyperglycemia ratio (SHR) for new-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI). MATERIALS AND METHODS This retrospective study included 2145 AMI patients without AF history between February 2014 and March 2018. SHR was calculated using fasting blood glucose (mmol/L)/[1.59*HbA1c (%)-2.59]. The association between SHR and post-MI NOAF was assessed with multivariable logistic regression analyses. The primary outcome was a composite of cardiac death, heart failure hospitalisation, recurrent MI, and ischaemic stroke (MACE). Cox regression-adjusted hazard ratios with 95% confidence intervals (CI) were estimated for MACE. RESULTS A total of 245 (11.4%) patients developed NOAF. In the multivariable logistic regression analyses, SHR (each 10% increase) was significantly associated with increased risks of NOAF in the whole population (OR: 1.05, 95% CI: 1.01-1.10), particularly in non-diabetic individuals (OR:1.08, 95% CI: 1.01-1.17). During a median follow-up of 2.7 years, 370 (18.5%) MACEs were recorded. The optimal cut-off value of SHR for MACE prediction was 1.119. Patients with both high SHR (≥1.119) and NOAF possessed the highest risk of MACE compared to those with neither high SHR nor NOAF after multivariable adjustment (HR: 2.18, 95% CI: 1.39-3.42), especially for diabetics (HR: 2.63, 95% CI: 1.41-4.91). Similar findings were observed using competing-risk models. CONCLUSIONS SHR is an independent predictor of post-MI NOAF in non-diabetic individuals. Diabetic patients with both high SHR and NOAF had the highest risk of MACE, suggesting that therapies targeting SHR may be considered in these patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT03533543.
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Affiliation(s)
- Jiachen Luo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiqiang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoming Qin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingxu Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiangdong Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenming Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Baoxin Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yidong Wei
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Trujillo-Flores D, García-Mendoza JDJ. Atrial fibrillation de novo in acute coronary syndrome. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:181-190. [PMID: 38648718 PMCID: PMC11160543 DOI: 10.24875/acm.23000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/15/2023] [Indexed: 04/25/2024] Open
Abstract
One of the complications during an acute coronary syndrome event is the presence of arrhythmias. Among them, those of the supraventricular type, especially atrial fibrillation, carry a poor prognosis both in the short and long term, being the cause of situations such as cerebrovascular event, ventricular arrhythmias, and increased mortality. The arrhythmia tends to appear in a certain population group with particular risk factors during the index event in approximately 10% of cases. Appropriate treatment at the time of its onset, thanks to the use of drugs that modulate heart rate, rhythm, and anticoagulant management in the most vulnerable groups, will lead to a less bleak outcome for these patients.
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Affiliation(s)
- David Trujillo-Flores
- Servicio de Consulta Externa de Cardiología
- Servicio de Hospitalización de Cardiología
- Servicio de Ecocardiografía
| | - José de J. García-Mendoza
- Departamento de Electrocardiografía. Clínica Hospital Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicios de los Poderes del Estado de Puebla, Tehuacán, Pue., México
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Yue B, Hou Q, Bredehorst J, Han Q, Zhang B, Zhang C, Zhang J, Chen S, Wu S, Li K. Atrial fibrillation increases the risk of new-onset myocardial infarction amongst working-age population: a propensity-matched study. Herz 2023; 48:408-412. [PMID: 37264124 DOI: 10.1007/s00059-023-05181-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/26/2023] [Accepted: 04/02/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the association between atrial fibrillation (AF) and new-onset myocardial infarction (MI) among a working-age population in an industrial city of North China. METHODS In total 77,670 participants aged under 60 years were selected for this cohort study. Participants were divided into an AF group (n = 121) and a non-AF group (n = 74,565) based on their medical histories. Thereafter, 121 participants from the AF group were propensity-matched with 363 participants from the non-AF group. All participants were followed up from June 2006 to December 2020; new-onset MI was regarded as the endpoint of this study. Multivariate Cox proportional hazards regression analysis models were designed to analyze the correlation between AF and new-onset MI. RESULTS During the 14-year follow-up, eight cases of new-onset MI were documented in the AF group, while five cases were documented in the non-AF group. The cumulative incidence of new-onset MI in the AF group (7.40%) was markedly higher than in the non-AF group (1.41%; p < 0.001). Atrial fibrillation was associated with an increased risk of new-onset MI in both univariate analysis (hazard ratio: 5.202, 95% confidence interval [CI]: 1.700-15.913) and multivariable-adjusted analysis (hazard ratio: 5.335, 95% CI: 1.683-16.910). CONCLUSION Atrial fibrillation increased the risk of new-onset MI amongst working-age individuals in an industrial city of North China.
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Affiliation(s)
- Bocheng Yue
- Department of Cardiology, Tangshan Gongren Hospital, NO.27, Wenhua Road, 063000, Tangshan, Lubei District, China
| | - Qiqi Hou
- Hebei Medical University, Shijiazhuang, China
| | | | - Quanle Han
- Department of Cardiology, Tangshan Gongren Hospital, NO.27, Wenhua Road, 063000, Tangshan, Lubei District, China.
- Hebei Medical University, Shijiazhuang, China.
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China.
| | - Boheng Zhang
- Department of Cardiology, Tangshan Gongren Hospital, NO.27, Wenhua Road, 063000, Tangshan, Lubei District, China
| | - Chao Zhang
- Catheterization Unit, Tangshan Gongren Hospital, Tangshan, China
| | - Jiawei Zhang
- Department of Rehabilitation Medicine, Kailuan Tangjiazhuang Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Kangbo Li
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
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Lancini D, Prasad A, Thomas L, Atherton J, Martin P, Prasad S. Predicting new onset atrial fibrillation post acute myocardial infarction: Echocardiographic assessment of left atrial size. Echocardiography 2023. [PMID: 37096734 DOI: 10.1111/echo.15574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/23/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) commonly occurs following acute myocardial infarction (AMI). Left atrial (LA) size has been reported to predict new onset AF in this cohort, however, the optimal metric of left atrial size for risk stratification following AMI is unknown. METHODS Patients presenting to a tertiary hospital with incident AMI (NSTEMI or STEMI) and no history of AF were recruited. All patients underwent guideline-based workup and management for AMI, including transthoracic echocardiographic assessment. Three alternative metrics of left atrial size were determined: LA area, maximal and minimal LA volume indexed to body surface area (LAVImax and LAVImin). The primary endpoint was new onset AF diagnoses. RESULTS Four hundred thirty three patients were included in the analysis, of which 7.1% had a new diagnosis of AF within a median follow-up of 3.8 years. Univariate predictors of incident AF included age, hypertension, revascularization with CABG, NSTEMI presentation, right atrial area, and all three metrics of LA size. Among three multivariable models created for the prediction of new onset AF utilizing alternate metrics of LA size, LAVImin was the only LA size metric found to be an independent predictor. CONCLUSIONS LAVImin is an independent predictor of new onset AF post AMI. LAVImin outperforms echocardiographic assessment of diastolic dysfunction and alternative metrics of LA size (including LA area and LAVImax) for risk stratification. Further studies are needed to validate our findings in post AMI patients, and evaluate whether LAVImin holds similar advantages over LAVImax in other cohorts.
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Affiliation(s)
- Daniel Lancini
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Aveechal Prasad
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Liza Thomas
- Cardiology Department, Westmead Hospital, Sydney, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | - John Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Paul Martin
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sandhir Prasad
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Griffith University, Brisbane, Australia
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Jaakkola S, Paana T, Airaksinen J, Sipilä J, Kytö V. Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction. J Clin Med 2022; 11:jcm11237090. [PMID: 36498665 PMCID: PMC9739941 DOI: 10.3390/jcm11237090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
The CHA2DS2-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We studied the usefulness of CHA2DS2-VASc in predicting NOAF and IS in a long-term follow-up after MI. Consecutive MI patients without baseline AF (n = 70,922; mean age: 68.2 years), discharged from 20 hospitals in Finland during 2005−2018, were retrospectively studied using national registries. The outcomes of interest after discharge were NOAF- and IS-assessed with competing risk analyses at one and ten years. The median follow-up was 4.2 years. The median baseline CHA2DS2-VASc score was 3 (IQR 2−5). The likelihood of both NOAF and NOAF-related IS increased stepwise with this score at one and ten years (all p < 0.0001). The one-year-adjusted subdistribution hazard ratio (sHR) was 4.03 (CI 3.68−4.42) for NOAF in patients with CHA2DS2-VASc scores ≥6 points. The cumulative incidence of IS was 15.2% in patients with NOAF vs. 6.2% in patients without AF at 10 years after MI (adj. sHR 2.12; CI 1.98−2.28; p < 0.0001). Coronary artery bypass surgery was associated with a higher NOAF incidence compared to percutaneous coronary intervention (adj. sHR 1.87; CI 1.65−2.13; p < 0.0001 one year after MI). The CHA2DS2-VASc score is a simple tool used to estimate the long-term risk of NOAF and IS after MI in patients without baseline AF. Coronary bypass surgery is associated with an increased NOAF incidence after MI.
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Affiliation(s)
- Samuli Jaakkola
- Heart Center, Turku University Hospital, University of Turku, 20521 Turku, Finland
- Correspondence:
| | - Tuomas Paana
- Heart Center, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Jussi Sipilä
- Department of Neurology, Siun Sote, North Karelia Central Hospital, 80210 Joensuu, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, University of Turku, 20521 Turku, Finland
- Turku Clinical Research Center, Turku University Hospital, 20521 Turku, Finland
- Center for Population Health Research, Turku University Hospital, University of Turku, 20521 Turku, Finland
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8
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Pallisgaard J, Greve AM, Lock-Hansen M, Thune JJ, Fosboel EL, Devereux RB, Okin PM, Gislason GH, Torp-Pedersen C, Bang CN. Atrial fibrillation onset before heart failure or vice versa: what is worst? A nationwide register study. Europace 2022; 25:283-290. [PMID: 36349557 PMCID: PMC9935045 DOI: 10.1093/europace/euac186] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Atrial fibrillation (AF) and heart failure (HF) often coexist. However, whether AF onset before HF or vice versa is associated with the worst outcome remains unclear. A consensus of large studies can guide future research and preventive strategies to better target high-risk patients. METHODS AND RESULTS We included all Danish cases with the coexistence of AF and HF (2005-17) using nationwide registries. Patients were divided into three separate groups (i) AF before HF, (ii) HF before AF, or (iii) AF and HF diagnosed concurrently (±30 days). Adjusting landmark Cox analyses (index date was the time of the latter diagnosis of AF or HF) were used for evaluating the association of the three groups with a composite outcome of ischaemic stroke or death. Among a total of 49 042 patients included, 40% had AF before HF, 27% had HF before AF, and 33% had AF and HF diagnosed concurrently. The composite endpoint accrued more often in patients with HF before AF compared to the two other groups (<0.001), and this remained significant in the adjusted analyses with hazard ratios (95% confidence intervals) of 1.26 (1.22-1.30) compared to AF before HF. Finally, antihypertensive treatment, oral anticoagulants, amiodarone, statins, and AF ablation were associated with a lower hazard ratio of the composite endpoint (all < 0.001). CONCLUSIONS In this large Danish national cohort, diagnosis of HF before AF was associated with an increased absolute risk of death compared to AF before HF and AF and HF diagnosed concurrently. Antihypertensive treatment, oral anticoagulants, amiodarone, statins, and AF ablation may improve prognosis.
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Affiliation(s)
- Jannik Pallisgaard
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen 2900, Denmark
| | - Anders M Greve
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University, Copenhagen 2100, Denmark
| | - Morten Lock-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen 2900, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen University, Copenhagen 2400, Denmark
| | - Emil Loldrup Fosboel
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University, Copenhagen 2100, Denmark
| | - Richard B Devereux
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Peter M Okin
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen 2900, Denmark,Department of Research, Danish Heart Foundation, Copenhagen 1120, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Copenhagen University, Copenhagen 3400, Denmark
| | - Casper N Bang
- Corresponding author. Tel: +4538635000. E-mail address:
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9
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Ayinde H, Riedle B, Ojo A, Abugroun A, Girotra S, Polgreen L. Prognostic Significance of Newly Diagnosed Atrial Fibrillation After Acute Myocardial Infarction: A Study of 184,980 Medicare Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:37-43. [PMID: 35835653 PMCID: PMC10776021 DOI: 10.1016/j.carrev.2022.06.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/28/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Abstract
We aimed to determine whether newly diagnosed atrial fibrillation (AF) predicted cardiovascular events and death after myocardial infarction (AMI) in a large nationwide cohort of patients. All Medicare beneficiaries aged >65 years who were discharged alive after a diagnosis of AMI between January 1, 2007 and December 31, 2008 were identified. Main exposure was a diagnosis of AF during admission or within 90 days after discharge. Primary outcome was a composite of recurrent AMI, stroke and all-cause mortality. Secondary outcomes were each of recurrent AMI, stroke and all-cause mortality. We used Cox proportional hazards regression to assess the relationship between AF and time-to-event outcomes with follow up ending at 3 years. Of 184,980 patients, 9.1 % had AF; 40.6 % were male; 82.8 % were non-Hispanic whites. Mean age was 79.1 ± 8.1 years. Overall, 15.7 % had subsequent AMI, 5.7 % had stroke and 43.9 % died during a mean follow up of 26.4 months. AF was associated with a significantly increased risk of the primary outcome (Hazard ratio (HR) = 1.10; 95 % confidence interval (CI): 1.07-1.12). AF was also separately associated with significantly increased risk of recurrent AMI (HR = 1.09; 95 % CI: 1.04-1.14), stroke (HR = 1.29; 95 % CI: 1.21-1.37), and death (HR = 1.09; 95 % CI: 1.06-1.12). Neither age, race nor sex modified the effects of AF on primary or secondary outcomes. In conclusion, AF is a significant predictor of adverse cardiovascular outcomes and mortality after AMI. Further studies are needed to understand mechanisms by which AF alters outcomes in survivors of AMI.
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Affiliation(s)
- Hakeem Ayinde
- Division of Cardiology, Novant Health Heart & Vascular Institute, Charlotte, NC, USA.
| | - Benjamin Riedle
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Amole Ojo
- Division of Cardiovascular Diseases, University of Rochester Medical Center, Rochester, NY, USA
| | - Ashraf Abugroun
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Saket Girotra
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Linnea Polgreen
- Department of Pharmacy Practice and Science/Division of Health Services Research, University of Iowa, Iowa City, IA, USA
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10
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Wu J, Hou Q, Han Q, Mao R, Yue B, Yu J, Chen S, Wu S, Li K. Atrial fibrillation is an independent risk factor for new-onset myocardial infarction: a prospective study. Acta Cardiol 2022; 78:341-348. [PMID: 36251263 DOI: 10.1080/00015385.2022.2129184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) and myocardial infarction (MI) share common cardiovascular risk factors, therefore coexistence of AF and MI is very common, in addition, both AF and MI aggravate and exacerbate each other through multiple pathological processes. The aim of this study is to investigate whether AF increases the risk of new-onset MI. METHODS In total 171,086 participants from an industrial city in North China were selected and enrolled in this prospective cohort study, participants were divided into the AF group or the non-AF group according to their medical history. 1542 participants from the AF group were propensity-matched with 4626 participants from the non-AF group. All the participants were followed up every 2 years from June 2006 to December 2020, the median follow-up was 14.25 years and the endpoint of this study was new-onset MI. The association between AF and new-onset MI was analysed by using both univariate and multivariate Cox proportional hazards regression analysis. RESULTS New-onset MI was documented in 56 cases from the AF group and 98 cases from the non-AF group, respectively, the cumulative incidence of new-onset MI in the AF group (3.73%) was significantly higher than that in the non-AF group (2.23%) (p < 0.01). In a univariate analysis, AF was associated with an increased risk of new-onset MI (hazard ratio: 1.73, 95% confidence interval: 1.24-2.40), in two multivariable-adjusted analyses, AF was still associated with an increased risk of new-onset MI (hazard ratio: 1.78, 95% confidence interval, 1.28-2.47). CONCLUSIONS AF is an independent risk factor for new-onset MI in an industrial population of North China.
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Affiliation(s)
- Jianmei Wu
- Department of Cardiovascular Surgery, Tangshan Gongren Hospital, Tangshan, China
| | - Qiqi Hou
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China.,Graduate School, Hebei Medical University, Shijiazhuang, China
| | - Quanle Han
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China.,Graduate School, Hebei Medical University, Shijiazhuang, China.,School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Ruiying Mao
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China
| | - Bocheng Yue
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China
| | - Jing Yu
- Department of Intervention, Tangshan Gongren Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China.,Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Kangbo Li
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
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11
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Management of Oral Anticoagulation and Antiplatelet Therapy in Post-Myocardial Infarction Patients with Acute Ischemic Stroke with and without Atrial Fibrillation. J Clin Med 2022; 11:jcm11133894. [PMID: 35807178 PMCID: PMC9267324 DOI: 10.3390/jcm11133894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
The association between atrial fibrillation (AF), acute coronary syndrome (ACS), and stroke is a complex scenario in which the assessment of both thrombotic and hemorrhagic risk is necessary for scheduling an individually tailored therapeutic plan. Recent clinical trials investigating new antithrombotic drugs and dual and triple pathways in high-risk cardiovascular patients have revealed a new therapeutic scenario. In this paper, we review the burden of ischemic stroke (IS) in patients post-myocardial infarction with and without atrial fibrillation and the possible therapeutic strategies from a stroke point of view.
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12
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Bang CN, Greve AM, Køber L, Muthiah A, Kjeldsen SE, Julius S, Wachtell K, Devereux RB, Okin PM. Incident atrial fibrillation and heart failure in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: The present study investigated the appearance and severity of atrial fibrillation (AF) and heart failure (HF) in 8,702 hypertensive patients with left ventricular hypertrophy (LVH) receiving antihypertensive treatment in a prospective trial.
Methods: Patients who had a history of AF or HF were not included, and the participants had sinus rhythm when they were randomly allocated to blinded study medication. Endpoints were adjudicated.
Results: Incident AF occurred in 679 patients (7.8%) and HF in 246 patients (2.8%) during 4.7 ± 1.1 years mean follow-up. Incident AF was associated with a > 4-fold increased risk of developing subsequent HF [hazards ratios (HRs) = 4.7; 95% confidence intervals (CIs), 3.1–7.0; P < 0.001] in multivariable Cox analyses adjusting for age, sex, race, randomized treatment, standard cardiovascular risk factors and incident myocardial infarction. The development of HF as a time-dependent variable was associated with a multivariable-adjusted 3-fold increase of the primary study endpoint (HRs = 3.11; 95% CIs, 1.52–6.39; P < 0.001) which was a composite of myocardial infarction, stroke or cardiovascular death. Incident HF was associated with a > 3-fold increased risk of developing subsequent AF (HRs = 3.3; 95% CIs, 2.3–4.9; P < 0.001). This development of AF was associated with a > 2-fold increase of the composite primary study endpoint in multivariable Cox analysis (HRs = 2.26; 95% CIs, 1.09–4.67; P = 0.028).
Conclusions: Incident atrial fibrillation and heart failure are associated with increased risk of the other in treated hypertensive patients with left ventricular hypertrophy. Such high-risk hypertensive patients who subsequently develop both atrial fibrillation and heart failure have particular high risk of composite myocardial infarction, stroke or cardiovascular death (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Casper N. Bang
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA 2Department of Cardiology, Frederiksberg and Bispebjerg Hospital, 2200 Copenhagen, Denmark
| | - Anders M. Greve
- 3Department of Clinical Biochemistry, Rigshopsitalet, 2200 Copenhagen, Denmark
| | - Lars Køber
- 4The Heart Center, Department of Cardiology, Rigshospitalet, 2200 Copenhagen, Denmark
| | - Anujan Muthiah
- 5Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- 5Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway 6Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- 6Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kristian Wachtell
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Richard B. Devereux
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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13
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Buchta P, Kalarus Z, Mizia-Stec K, Myrda K, Skrzypek M, Ga Sior M. De novo and pre-existing atrial fibrillation in acute coronary syndromes: impact on prognosis and cardiovascular events in long-term follow-up. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:1129-1139. [PMID: 34718473 DOI: 10.1093/ehjacc/zuab091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
AIMS The aim of the study was to compare in-hospital and long-term prognosis in patients with acute coronary syndromes (ACS) and de novo vs. pre-existing atrial fibrillation (AF). Atrial fibrillation increases the risk of serious adverse events including death in patients with ACS. However, it is unclear whether de novo and pre-existing AF portend a different risk. METHODS AND RESULTS We analysed the incidence, clinical characteristics, and in-hospital and long-term outcomes in patients with AF and ACS based on combined data from Polish Registry of Acute Coronary Syndrome (PL-ACS) (n = 581 843) and SILICARD (n = 852 063) databases. Atrial fibrillation at admission was diagnosed in of 6.16% patients [de novo: 1129 (2.46%); pre-existing: 1691 (3.7%)]. Groups were compared (N = 1023 vs. 1023) after matching for relevant clinical factors. De novo and pre-existing AF differed in in-hospital diuretic (52% vs. 58%; P = 0.008) and aldosterone inhibitor (27.5% vs. 32.5%; P = 0.02) use, Thrombolysis In Myocardial Infarction (TIMI) flow before percutaneous coronary intervention (P = 0.016), and diuretic (52.1% vs. 58%; P = 0.008) and oral anticoagulant (27.5% vs. 32.5%; P = 0.018) use at discharge. In-hospital mortality in the de novo AF group was significantly higher (13.1% vs. 8.31%; P = 0.0005). Post-discharge 12-month survival was similar between groups (14.5% vs. 15.3%, P = 0.63). Long-term re-hospitalization due to heart failure (22.7% vs. 17.2%; P < 0.005) and medical contact due to AF (48.4% vs. 26.1%, P < 0.0001) rates were higher in the group with pre-existing AF, without the difference of stroke or myocardial infarction occurrence. CONCLUSION De novo AF accounts for 40% of all AF cases in ACS patients and is an unfavourable in-hospital prognostic factor. The occurrence of de novo AF during ACS should require special attention and caution in the treatment of these patients.
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Affiliation(s)
- Piotr Buchta
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Center, ul. Ziolowa 47, 40-635 Katowice, Poland
| | - Krzysztof Myrda
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Michał Skrzypek
- Department of Biostatistics, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, ul. Piekarska 18, 41-902 Bytom, Poland
| | - Mariusz Ga Sior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
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14
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Chiang CH, Hung WT, Huang WC, Jheng YC, Lai WY, Lin YY, Lin TW, Lin KC, Cheng CC, Kuo FY. The risk of stroke after acute myocardial infarction in patients with and without atrial fibrillation: A nationwide cohort study. J Chin Med Assoc 2021; 84:1126-1134. [PMID: 34898532 DOI: 10.1097/jcma.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) and atrial fibrillation (AF) are risk factors for stroke. The risk of stroke after AMI may differ between patients with and without AF. The aim of this study was to evaluate the impact of AF on stroke in patients after the first AMI. METHODS This was a retrospective, nationwide cohort study. Patients with a primary diagnosis of a first AMI between 2000 and 2012 were included. All patients were followed up until ischemic stroke or transient ischemic attack (TIA), or December 31, 2012, whichever occurred first. Kaplan-Meier cumulative survival curves were constructed to compare ischemic stroke or TIA between AMI patients with and without AF. RESULTS A total of 170 472 patients were enrolled in this study. Among them, 8530 patients with AF were identified. The propensity score matching technique was used to match 8530 patients without AF of similar ages and sexes. Overall, the 12-year stroke rate was significantly higher in patients with AF than in those without AF (log-rank p < 0.001), including different sexes, ages, and interventional therapy subgroups. Patients with pre-existing AF had higher stroke rates than those with newly diagnosed AF in male sex, age below 65 years, and those receiving interventional therapy subgroups. In Cox proportional-hazard regression analysis, AF was an independent risk factor for stroke after the first AMI (hazard ratio, 1.67; 95% CI: 1.5-1.87). CONCLUSION AF significantly increases stroke risk after the first AMI. In patients with AF, those with pre-existing AF have higher stroke risks in male sex, age below 65 years, and those with interventional therapy than those with newly diagnosed AF.
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Affiliation(s)
- Cheng-Hung Chiang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wan-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Chun Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Ying-Chun Jheng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Yi Lai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ying Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Wei Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Yu Kuo
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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15
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Wang S, Li J, Sun L, Cai J, Wang S, Zeng L, Sun S. Application of machine learning to predict the occurrence of arrhythmia after acute myocardial infarction. BMC Med Inform Decis Mak 2021; 21:301. [PMID: 34724938 PMCID: PMC8560220 DOI: 10.1186/s12911-021-01667-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early identification of the occurrence of arrhythmia in patients with acute myocardial infarction plays an essential role in clinical decision-making. The present study attempted to use machine learning (ML) methods to build predictive models of arrhythmia after acute myocardial infarction (AMI). Methods A total of 2084 patients with acute myocardial infarction were enrolled in this study. (All data is available on Github: https://github.com/wangsuhuai/AMI-database1.git). The primary outcome is whether tachyarrhythmia occurred during admission containing atrial arrhythmia, ventricular arrhythmia, and supraventricular tachycardia. All data is randomly divided into a training set (80%) and an internal testing set (20%). Apply three machine learning algorithms: decision tree, random forest (RF), and artificial neural network (ANN) to learn the training set to build a model, then use the testing set to evaluate the prediction performance, and compare it with the model built by the Global Registry of Acute Coronary Events (GRACE) risk variable set. Results Three ML models predict the occurrence of tachyarrhythmias after AMI. After variable selection, the artificial neural network (ANN) model has reached the highest accuracy rate, which is better than the model constructed using the Grace variable set. After applying SHapley Additive exPlanations (SHAP) to make the model interpretable, the most important features are abnormal wall motion, lesion location, bundle branch block, age, and heart rate. Among them, RBBB (odds ratio [OR]: 4.21; 95% confidence interval [CI]: 2.42–7.02), ≥ 2 ventricular walls motion abnormal (OR: 3.26; 95% CI: 2.01–4.36) and right coronary artery occlusion (OR: 3.00; 95% CI: 1.98–4.56) are significant factors related to arrhythmia after AMI. Conclusions We used advanced machine learning methods to build prediction models for tachyarrhythmia after AMI for the first time (especially the ANN model that has the best performance). The current study can supplement the current AMI risk score, provide a reliable evaluation method for the clinic, and broaden the new horizons of ML and clinical research. Trial registration Clinical Trial Registry No.: ChiCTR2100041960. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01667-8.
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Affiliation(s)
- Suhuai Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Jingjie Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Lin Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Jianing Cai
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shihui Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Linwen Zeng
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shaoqing Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
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16
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Borovac JA, Kwok CS, Mohamed MO, Fischman DL, Savage M, Alraies C, Kalra A, Nolan J, Zaman A, Ahmed J, Bagur R, Mamas MA. The Predictive Value of CHA2DS2-VASc Score on In-Hospital Death and Adverse Periprocedural Events Among Patients With the Acute Coronary Syndrome and Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention: A 10-Year National Inpatient Sample (NIS) Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:61-68. [DOI: 10.1016/j.carrev.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/12/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023]
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17
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Sampling designs for rare time-dependent exposures: a comparison of the nested exposure case-control design and exposure density sampling. Epidemiol Infect 2021; 149:e122. [PMID: 33888170 PMCID: PMC8165129 DOI: 10.1017/s095026882100090x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In extensive cohort studies, the ascertainment of covariate information on all individuals can be challenging. In hospital epidemiology, an additional issue is often the time-dependency of the exposure of interest. We revisit and compare two sampling designs constructed for rare time-dependent exposures and possibly common outcomes – the nested exposure case-control design and exposure density sampling. Both designs enable efficient hazard ratio estimation by sampling all exposed individuals but only a small fraction of the unexposed ones. Moreover, they account for time-dependent exposure to avoid immortal time bias. We evaluate and compare their performance using data of patients hospitalised in the neuro-intensive care unit at the Burdenko Neurosurgery Institute in Moscow, Russia. Three different types of hospital-acquired infections with different prevalence are considered. Additionally, inflation factors, a primary performance measure, are discussed. We enhance both designs to allow for a competitive analysis of combined and competing endpoints compared to the full cohort approach while substantially reducing the amount of necessary information. Nonetheless, exposure density sampling outperforms the nested exposure case-control design concerning efficiency and accuracy in most considered settings.
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18
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Chen L, Fu G, Jiang C. Mendelian randomization as an approach to assess causal effects of inflammatory bowel disease on atrial fibrillation. Aging (Albany NY) 2021; 13:12016-12030. [PMID: 33824227 PMCID: PMC8109086 DOI: 10.18632/aging.202906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Background: Despite growing evidence indicating that patients with inflammatory bowel disease (IBD) have an increased risk of atrial fibrillation (AF), owing to the potential biases of confounding effects and reverse causation, the specific relationship between IBD and AF remains controversial. The aim of this study is to determine whether there is a causal effect of IBD on AF. Methods: A two-sample Mendelian randomization (MR) study was performed to evaluate the causal effect of IBD on AF. Statistical summaries for the associations between single nucleotide polymorphisms (SNPs) and traits of interest were obtained from independent consortia with European populations. The dataset of IBD was acquired from genome-wide association studies (GWAS), including more than 75,000 cases and controls. A GWAS with 60,620 AF cases and 970,216 controls was used to identify genetic variation underlying AF. The causal effect was estimated using the multiplicative random effects inverse-variance weighted method (IVW), followed by sensitivity analysis. Results: Using 81 SNPs, there was no evidence to suggest an association between genetically predicted IBD and risk of AF with multiplicative random-effects IVW MR analysis (odds ratio = 1.0000, 95% confidence interval: 0.9994 1.0005, p = 0.88). Conclusion: As opposed to current assumptions, no substantial evidence was found to support a causal role of IBD in the development of AF.
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Affiliation(s)
- LaiTe Chen
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - GuoSheng Fu
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - ChenYang Jiang
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
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19
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Niiyama M, Koeda Y, Suzuki M, Shibuya T, Kinuta M, Tosaka K, Fujiwara J, Kanehama N, Sasaki W, Shimoda Y, Ishida M, Itoh T, Morino Y. Coronary Flow Disturbance Phenomenon After Percutaneous Coronary Intervention Is Associated with New-Onset Atrial Fibrillation in Patients with Acute Myocardial Infarction. Int Heart J 2021; 62:305-311. [PMID: 33731528 DOI: 10.1536/ihj.20-560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI). Although previous studies have investigated mortality rates and the incidences of adverse events associated with new-onset AF (NOAF) in patients with AMI, the effects of emergency percutaneous coronary intervention (PCI) on the incidence of NOAF in patients with AMI remain unclear. The purpose of this study was to investigate the relationship of clinical characteristics, medical history, and the coronary flow disturbance phenomenon (TIMI < 3) following emergency PCI with NOAF in patients with AMI. Between 2012 and 2016, 731 patients with AMI underwent PCI at our facility. Among these, 52 had a history of chronic/paroxysmal AF before admission and were excluded. The remaining 679 patients (mean age 66.4 years, 532 males) were analyzed in this retrospective observational study.New-onset AF was observed in 45 patients (6.6%). In univariate analysis, the hazard ratios (HRs) for patient age (HR 1.04, 95%CI 1.02-1.07), Killip II-IV (HR 2.34, 95%CI 1.29-4.23), elevated D-dimer level (> 1.0 μg/mL; HR 3.32; 95%CI 1.77-6.23), and coronary flow disturbance phenomenon (HR 5.61; 95%CI 2.88-10.9) were significantly higher in the NOAF group. In multivariate analysis, an elevated D-dimer level (> 1.0 μg/mL; HR 2.44; 95%CI 1.17-5.11) and coronary flow disturbance phenomenon (HR 4.61; 95%CI 2.29-9.27) were found to be independent risk factors for NOAF. An elevated D-dimer level at admission and the presence of coronary flow disturbance phenomenon after PCI were risk factors for NOAF following emergency PCI in patients with AMI.
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Affiliation(s)
- Masanobu Niiyama
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yorihiko Koeda
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Miho Suzuki
- School of Medicine, Iwate Medical University
| | | | | | - Kengo Tosaka
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Jumpei Fujiwara
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Nozomu Kanehama
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Wataru Sasaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yudai Shimoda
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
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20
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Zykov MV, Butsev VV, Suleymanov RR. Myocardial Infarction Complicated by Ischemic Stroke: Risk Factors, Prognosis, Unresolved Problems and Possible Methods of Prevention. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present work is devoted to the analysis of modern publications on various aspects of the development and course of ischemic stroke in the presence of acute myocardial infarction. A literature search was conducted on the websites of cardiological and neurological societies, as well as on the PubMed, EMBASE, eLibrary databases using the keywords: myocardial infarction, acute coronary syndrome, stroke, acute cerebrovascular accident, myocardial infarction, acute coronary syndrome, stroke. The authors of this review found that although stroke is a relatively rare complication of myocardial infarction, its prevention is an extremely significant task, since it is associated with high mortality, disability and a significant increase in the cost of treatment. So, it is extremely important to detect thrombosis of the left ventricular cavity in a timely manner, to register preexisting atrial fibrillation that occurs earlier or for the first time, followed by the appointment of anticoagulant therapy. Timely reperfusion treatment, the use of statins and modern dual antithrombotic therapy can reduce the risk of developing cerebrovascular accident in patients with myocardial infarction. It is likely that a decrease in the activity of subclinical inflammation after myocardial infarction will also reduce the risk of stroke, as was recently shown in the COLCOT study. Currently, it remains relevant to search for new knowledge about the risk factors for stroke, which complicated the course of myocardial infarction, which will allow developing more effective and personalized preventive measures in a patient with acute coronary syndrome.
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Affiliation(s)
- M. V. Zykov
- Research Institute for Complex Issues of Cardiovascular Diseases;
Sochi City Hospital №4
| | | | - R. R. Suleymanov
- District Cardiology Dispensary, Center for Diagnosis and Cardiovascular Surgery
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21
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Belkouche A, Yao H, Putot A, Chagué F, Rochette L, Danchin N, Fauchier L, Zeller M, Cottin Y. The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review. J Clin Med 2021; 10:E198. [PMID: 33430505 PMCID: PMC7826531 DOI: 10.3390/jcm10020198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/26/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022] Open
Abstract
This review was conducted to emphasize the complex interplay between atrial fibrillation (AF) and myocardial infraction (MI). In type 1 (T1) MI, AF is frequent and associated with excess mortality. Moreover, AF after hospital discharge for T1MI is not rare, suggesting the need to improve AF screening and to develop therapeutic strategies for AF recurrence. Additionally, AF is a common trigger for type 2 MI (T2MI), and recent data have shown that tachyarrhythmia or bradyarrhythmia could be a causal factor in, respectively, 13-47% or 2-7% of T2MI. In addition, AF is involved in T2MI pathogenesis as a result of severe anemia related to anticoagulants. AF is also an underestimated and frequent cause of coronary artery embolism (CE), as a situation at risk of myocardial infarction with non-obstructive coronary arteries. AF-causing CE is difficult to diagnose and requires specific management. Moreover, patients with both AF and chronic coronary syndromes represent a therapeutic challenge because the treatment of AF include anticoagulation, depending on the embolic risk, and ischemic heart disease management paradoxically includes antiplatelet therapy.
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Affiliation(s)
- Alban Belkouche
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
| | - Hermann Yao
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
| | - Alain Putot
- Department of Geriatry, University Teaching Hospital Dijon Bourgogne, 21000 Dijon, France;
| | - Frédéric Chagué
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
| | - Luc Rochette
- Team PEC2, EA 7460, University of Burgundy, 21078 Dijon, France; (L.R.); (M.Z.)
| | - Nicolas Danchin
- Department of Cardiology, University Teaching Hospital of Georges Pompidou, 75015 Paris, France;
| | - Laurent Fauchier
- Department of Cardiology, University Teaching Hospital of Trousseau and University François Rabelais, 37000 Tours, France;
| | - Marianne Zeller
- Team PEC2, EA 7460, University of Burgundy, 21078 Dijon, France; (L.R.); (M.Z.)
| | - Yves Cottin
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
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22
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Abstract
The population suffering from coronary heart disease (CHD) complicated by atrial fibrillation (AF) is rising rapidly. A strong correlation between the two diseases has been reported, and the many common risk factors they share may play prominent roles in their development. In addition, CHD can directly promote the progression of AF by affecting reentry formation, focal ectopic activity, and neural remodeling. At the same time, AF also affects CHD through three aspects: 1) atherosclerosis, 2) the mismatch of blood supply and oxygen consumption, and 3) thrombosis. In conclusion, CHD and AF can aggravate each other and seem to form a vicious cycle. For patients with CHD complicated by AF, principal studies and guidelines have focused on antithrombotic treatment and rhythm control, which are paramount for these patients. Of note, our review sheds light on the strategies to break the cycle of the two diseases, which may be fundamental to treat these patients and optimize the benefit.
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Affiliation(s)
- Feng Liang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Wang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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23
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Desai R, Hanna B, Singh S, Gupta S, Deshmukh A, Kumar G, Sachdeva R, Berman AE. Percutaneous Ventricular Assist Device vs. Intra-Aortic Balloon Pump for Hemodynamic Support in Acute Myocardial Infarction-Related Cardiogenic Shock and Coexistent Atrial Fibrillation: A Nationwide Propensity-Matched Analysis'. Am J Med Sci 2020; 361:55-62. [PMID: 33008567 DOI: 10.1016/j.amjms.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients suffering an acute myocardial infarction complicated by cardiogenic shock (AMICS) may experience clinical deterioration with concomitant atrial fibrillation (AF). Recent data suggest that percutaneous ventricular assist devices (pVADs) provide superior hemodynamic support over intra-aortic balloon pump (IABP) in AMICS. In patients with AF+AMICS, however, outcomes data comparing these two devices remain limited. METHODS Using the National Inpatient Sample datasets (2008-2014) and a propensity-score matched analysis, we compared the outcomes of AMICS+AF hospitalized patients undergoing PCI with pVAD vs. IABP support. RESULTS A total of 12,842 AMICS+AF patients were identified (pVAD=468, IABP=12,374). The matched groups (pVAD=443, IABP=443) were comparable in terms of mean age (70.3 ± 12.0 vs. 70.4 ± 11.0yrs, p = 0.92). The utilization of pVAD was higher in whites but lower in Medicare/Medicaid beneficiaries as compared to IABP. The pVAD group demonstrated higher rates of obesity (13.6% vs. 7.8%, p = 0.006) and dyslipidemia (48.4% vs. 41.8%, p = 0.05). There was no difference in the in-hospital mortality (40.5% vs. 36.8%, p = 0.25); however, pVAD group had a lower incidence of post-procedural MI and higher incidences of stroke (7.8% vs. 4.4%, p = 0.03), hemorrhage (5.6% vs. 2.3%, p = 0.01), discharges to home health care (13.5% vs. 10.1%, p<0.001) and to other facilities (29.1% vs. 24.9%, p<0.001) as compared to IABP group. There was no difference between the groups in terms of mean length of stay or hospital charges. CONCLUSIONS All-cause inpatient mortality was similar in AMICS+AF patients undergoing PCI who were treated with either pVAD or IABP. The pVAD group, however, experienced more complications while consuming greater healthcare resources.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States
| | - Bishoy Hanna
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Sandeep Singh
- Division of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sonu Gupta
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States
| | | | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States; Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States; Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States; Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Adam E Berman
- Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, United States; Division of Health Economics and Modeling, Medical College of Georgia, Augusta University, Augusta, GA, United States.
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24
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Vitolo M, Javed S, Capodanno D, Rubboli A, Boriani G, Lip GYH. Antithrombotic treatment in atrial fibrillation patients undergoing percutaneous coronary interventions: focus on stent thrombosis. Expert Rev Cardiovasc Ther 2020; 18:587-600. [DOI: 10.1080/14779072.2020.1808463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Saad Javed
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Davide Capodanno
- Division of Cardiology, A.O.U. “Policlinico-vittorio Emanuele”, University of Catania, Catania, Italy
| | - Andrea Rubboli
- Deparment of Cardiovascular Diseases-AUSL Romagna, Division of Cardiology, S. Maria Delle Croci Hospital, Ravenna, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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25
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Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:74-84. [PMID: 32165880 PMCID: PMC7051868 DOI: 10.11909/j.issn.1671-5411.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To examine the prevalence of atrial fibrillation (AF), its impacts on cardiovascular disease (CVD) and all-cause mortality, and the associations between AF and inflammatory and serum biomarkers in a population-based sample of Muscovites. Methods The study is a secondary analysis of data from the Stress, Aging and Health in Russia (SAHR) survey that includes information on 1800 individuals with an average age of 68.5 years at baseline, and on their subsequent mortality during 7.4 years on average. AF is detected by 12-lead electrocardiogram (ECG) and 24-hour Holter monitoring. The statistical analysis includes proportional hazard and logistic regression models. Results Of the 1732 participants with relevant Holter data, AF was detected in 100 (74 by ECG and Holter, 26 by Holter only). The prevalence of AF was 5.8% for men and 7.4% for women. The fully adjusted model showed strongly elevated hazard of CVD and all-cause mortality in men and women with long non-self-limiting AF (LAF). LAF was found to be negatively associated with elevated total and low-density lipoprotein cholesterol and to be positively associated with elevated markers of inflammation in women. Conclusions The study assessed for the first time the prevalence and the risks of death related to AF among older Russians. LAF was shown to be a strong and independent predictor of CVD and all-cause mortality. AF is unlikely to contribute to the large excess male mortality in Russia. The finding that one-quarter of AF cases were detected only by Holter monitoring demonstrates the usefulness of diagnostics with prolonged ECG registration.
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26
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Kozieł M, Potpara TS, Lip GYH. Triple therapy in patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention/stenting. Res Pract Thromb Haemost 2020; 4:357-365. [PMID: 32211570 PMCID: PMC7086461 DOI: 10.1002/rth2.12319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/25/2022] Open
Abstract
Patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) are at high risk of stroke, recurrent coronary ischemic events, and cardiovascular mortality. The composition of antithrombotic therapy including an oral anticoagulant and antiplatelet drug(s) should be tailored according to the individual patient's risk profile, to reduce the bleeding risk and maintain antithrombotic effect. There is no single antithrombotic treatment regimen that would fit to all patients with AF and ACS. However, available data promote the use of full-dose direct oral anticoagulants (DOACs) (dabigatran 150 mg twice daily or apixaban 5 mg twice daily) or rivaroxaban 15 mg once daily in patients with AF and ACS or percutaneous coronary intervention (PCI). For many patients, a DOAC plus P2Y12 inhibitor early after ACS and/or PCI would be optimal, whereas a longer course of triple therapy should be used in patients at high thrombotic risk.
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Affiliation(s)
- Monika Kozieł
- Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart & Chest HospitalLiverpoolUK
- Division of Medical Sciences in ZabrzeDepartment of CardiologyCongenital Heart Diseases and ElectrotherapyMedical University of SilesiaKatowicePoland
| | - Tatjana S. Potpara
- Cardiology ClinicClinical Center of SerbiaBelgradeSerbia
- School of MedicineBelgrade UniversityBelgradeSerbia
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart & Chest HospitalLiverpoolUK
- Division of Medical Sciences in ZabrzeDepartment of CardiologyCongenital Heart Diseases and ElectrotherapyMedical University of SilesiaKatowicePoland
- School of MedicineBelgrade UniversityBelgradeSerbia
- Aalborg Thrombosis Research UnitDepartment of Clinical MedicineAalborg UniversityAalborgDenmark
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27
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Sonu G, Rupak D, Bishoy H, Abhishek D, Gautam K, Rajesh S, Adam EB. The Impact of Atrial Fibrillation on In-Hospital Outcomes in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock Undergoing Coronary Revascularization with Percutaneous Ventricular Assist Device Support. J Atr Fibrillation 2020; 12:2179. [PMID: 32435351 DOI: 10.4022/jafib.2179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/05/2019] [Accepted: 12/25/2019] [Indexed: 01/19/2023]
Abstract
Background Atrial fibrillation (AF) is common in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) requiring percutaneous ventricular assist device (pVAD-Impella®) support during percutaneous coronary interventions (PCI). We evaluated the effects of a coexistent diagnosis of AF on clinical outcomes in patients with AMI-CS undergoing PCI with pVAD support. Methods The National Inpatient Sample (2008-2014) was queried to identify patients with AMICS requiring PCI with pVAD support and had a concomitant diagnosis of AF. Propensity-matched cohorts (AF+ vs AF-) were compared for in-hospital outcomes. Results A total of 840 patients with AMICS requiring PCI with pVAD support (420 AF+ vs 420 AF-) were identified in the matched cohort. Patients with AF were older (mean 69.7±12.0 vs 67.9±11.3 yrs, p=0.030). All-cause in-hospital mortality rates between the two groups were similar (40.5% vs 36.7%, p=0.245); however, higher postprocedural respiratory complications (9.5% vs 4.8%, p=0.007) were seen in AF+ group. In-hospital cardiac arrests were more frequent in the AF- group (32.0% vs 19.2%, p<0.001). We examined the length of stay (LOS), transfer to other facilities, and hospital charges as metrics of health care resource consumption and found that the AF+ cohort experienced fewer routine discharges (13.1% vs 30.2%), more frequent transfers to other facilities including skilled nursing facilities or intermediate care facilities (27.3% vs 17.8%; p<0.001), more frequently required the use of home health care (14.3% vs 7.1%; p<0.001). The mean LOS (11.9±10.1 vs 9.11±6.8, p<0.001) and hospital charges ($308,478 vs $277,982, p=0.008) were higher in the AF+ group. Conclusions In patients suffering AMICS requiring PCI and pVAD support, a coexistent diagnosis of AF was not associated with an increase in all-cause in-hospital mortality as compared to patients without AF. However, healthcare resource consumption as assessed by various metrics was consistently greater in the AF+ group.
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Affiliation(s)
- Gupta Sonu
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA.,Authors share equal contribution to the manuscript
| | - Desai Rupak
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA.,Authors share equal contribution to the manuscript
| | - Hanna Bishoy
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Kumar Gautam
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sachdeva Rajesh
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA.,Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA.,Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - E Berman Adam
- Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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28
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Feifel J, Gebauer M, Schumacher M, Beyersmann J. Nested exposure case-control sampling: a sampling scheme to analyze rare time-dependent exposures. LIFETIME DATA ANALYSIS 2020; 26:21-44. [PMID: 30426275 DOI: 10.1007/s10985-018-9453-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
For large cohort studies with rare outcomes, the nested case-control design only requires data collection of small subsets of the individuals at risk. These are typically randomly sampled at the observed event times and a weighted, stratified analysis takes over the role of the full cohort analysis. Motivated by observational studies on the impact of hospital-acquired infection on hospital stay outcome, we are interested in situations, where not necessarily the outcome is rare, but time-dependent exposure such as the occurrence of an adverse event or disease progression is. Using the counting process formulation of general nested case-control designs, we propose three sampling schemes where not all commonly observed outcomes need to be included in the analysis. Rather, inclusion probabilities may be time-dependent and may even depend on the past sampling and exposure history. A bootstrap analysis of a full cohort data set from hospital epidemiology allows us to investigate the practical utility of the proposed sampling schemes in comparison to a full cohort analysis and a too simple application of the nested case-control design, if the outcome is not rare.
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Affiliation(s)
- Jan Feifel
- Ulm University, Helmholtzstrasse 20, 89081, Ulm, Germany.
| | - Madlen Gebauer
- Ulm University, Helmholtzstrasse 20, 89081, Ulm, Germany
| | - Martin Schumacher
- University Medical Center Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Jan Beyersmann
- Ulm University, Helmholtzstrasse 20, 89081, Ulm, Germany
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29
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Ohneberg K, Beyersmann J, Schumacher M. Exposure density sampling: Dynamic matching with respect to a time-dependent exposure. Stat Med 2019; 38:4390-4403. [PMID: 31313337 DOI: 10.1002/sim.8305] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2019] [Accepted: 06/06/2019] [Indexed: 11/12/2022]
Abstract
Estimating the potential risk associated with an exposure occurring over time requires complex statistical techniques, since ignoring the time from study entry until the exposure leads to potentially seriously biased effect estimates. A prominent example is estimating the effect of hospital-acquired infections on adverse outcomes in patients admitted to the intensive care unit. Exposure density sampling has been proposed as an approach to dynamic matching with respect to a time-dependent exposure. Firstly, exposure density sampling can be useful to reduce the workload of study follow up, as it includes all exposed but only a subset of the not yet exposed individuals. Secondly, it can help to obtain a comparable control group by including propensity score matching. In the present article, we provide the theoretical justification that data obtained by exposure density sampling can be analyzed as a left-truncated cohort. It is shown that exposure density sampling allows estimation of the effect of a time-dependent exposure as well as further baseline covariates on a subsequent event, with only minor loss in precision as compared with a full cohort analysis. The sampling is applied to a real data example (hospital-acquired infections in intensive care units) and in a simulation study. We also provide an estimate of the loss in precision in terms of an increased standard error in the reduced data set after exposure density sampling as compared with the full cohort.
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Affiliation(s)
- Kristin Ohneberg
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Freiburg Center for Data Analysis and Modeling, University of Freiburg, Freiburg, Germany
| | | | - Martin Schumacher
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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30
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Ohneberg K, Wolkewitz M, Schumacher M. RE: "RISK-SET MATCHING TO ASSESS THE IMPACT OF HOSPITAL-ACQUIRED BLOODSTREAM INFECTIONS". Am J Epidemiol 2019; 188:1192-1193. [PMID: 30759196 DOI: 10.1093/aje/kwz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
- Kristin Ohneberg
- Institute for Medical Biometry and Statistics, University Medical Center Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modeling, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Martin Wolkewitz
- Institute for Medical Biometry and Statistics, University Medical Center Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modeling, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Martin Schumacher
- Institute for Medical Biometry and Statistics, University Medical Center Freiburg, Freiburg, Germany
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31
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Usefulness of Antithrombotic Therapy in Patients With Atrial Fibrillation and Acute Myocardial Infarction. Am J Cardiol 2019; 123:12-18. [PMID: 30409413 DOI: 10.1016/j.amjcard.2018.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 11/20/2022]
Abstract
To examine patterns of preadmission and discharge antithrombotic therapies in coronary artery disease (CAD) and atrial fibrillation (AF) patients admitted for acute myocardial infarction (AMI), we performed a retrospective analysis of the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG), which captures consecutive AMI patients treated at participating US hospitals. We included patients with CAD, AF, and CHA2DS2-VASc score ≥2 admitted for AMI (07/01/2013-09/30/2016). In the 15,034 AMI patients with previous AF and CAD, median age was 75; 32% were female. Preadmission, 32% of patients were on P2Y12 inhibitors, 36% were anticoagulated, 72% were on aspirin, and 5% were on triple therapy. At discharge post-AMI, 73% were prescribed P2Y12 inhibitors and 41% anticoagulation. Discharge anticoagulation use did not vary directly with CHA2DS2-VASc score; 16% of previously anticoagulated patients had discontinued anticoagulation at discharge. In patients receiving anticoagulants at discharge, 27% used nonvitamin K antagonist oral anticoagulants. Triple therapy was prescribed in 23% at discharge; 27% of these were with nonvitamin K antagonist oral anticoagulants and 14% with prasugrel or ticagrelor. P2Y12 inhibitors and anticoagulants without aspirin were used in 2%. In conclusion, patients with previous CAD and AF are undertreated for both recurrent ischemic events and stroke prevention. After AMI hospitalization, P2Y12 inhibition was preferentially selected over oral anticoagulation.
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Wustrow I, Sarafoff N, Haller B, Rössner L, Sibbing D, Schüpke S, Ibrahim T, Anetsberger A, Schunkert H, Laugwitz KL, Kastrati A, Bernlochner I. Real clinical experiences of dual versus triple antithrombotic therapy after percutaneous coronary intervention. Catheter Cardiovasc Interv 2018; 92:1239-1246. [PMID: 30019824 DOI: 10.1002/ccd.27678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/16/2017] [Accepted: 05/10/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to assess the impact of omitting aspirin on clinical outcomes in a real-world collective of patients receiving oral anticoagulation (OAC) therapy who were treated with a current-generation drug-eluting stent (DES) or an everolimus-eluting bioresorbable vascular scaffold (BVS). BACKGROUND Limited data are available regarding the clinical benefit of triple antithrombotic therapy (TAT) with aspirin compared with dual antithrombotic therapy (DAT) without aspirin in patients undergoing percutaneous coronary intervention (PCI) and requiring OAC. METHODS In total, 237 patients were analyzed. The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE) within 1 year after PCI. Secondary outcomes were the individual components of the primary endpoint, cardiovascular death, and any bleeding according to Bleeding Academic Research Consortium (BARC) or Thrombolysis in Myocardial Infarction (TIMI) criteria. RESULTS Eighty-nine patients (37.6%) received DAT, and 148 (62.4%) received TAT. The rate of MACCE was significantly higher in DAT patients than in TAT patients (16 (18%) vs. 11 (7.4%); hazard ratio [HR] 2.73, 95% confidence interval [CI] 1.24-6.03; P = 0.01). The results of the multivariable Cox proportional hazards model including corrections for imbalances in baseline characteristics confirmed a significant independent association between DAT and MACCE (HRadj 3.14, 95% CI 1.31-7.54; P = 0.01). Major bleeding did not differ significantly between treatment groups. CONCLUSION DAT was associated with a significantly higher rate of MACCE than TAT after DES or BVS implantation. Further studies are required to evaluate the safety and efficacy of dual versus TAT after PCI in clinical practice.
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Affiliation(s)
- Isabel Wustrow
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Nikolaus Sarafoff
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Lisa Rössner
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Dirk Sibbing
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Aida Anetsberger
- Klinik für Anästhesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Isabell Bernlochner
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Luo J, Li H, Qin X, Liu B, Zhao J, Maihe G, Li Z, Wei Y. Increased risk of ischemic stroke associated with new-onset atrial fibrillation complicating acute coronary syndrome: A systematic review and meta-analysis. Int J Cardiol 2018; 265:125-131. [DOI: 10.1016/j.ijcard.2018.04.096] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/28/2018] [Accepted: 04/20/2018] [Indexed: 01/31/2023]
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Li CY, Chang CJ, Chung WJ, Lin CJ, Hsueh SK, Lee CH, Wu CJ, Tsai TH, Cheng CI. Assessment of CHA2DS2-VASc score for predicting cardiovascular and cerebrovascular outcomes in acute myocardial infarction patients. Medicine (Baltimore) 2018; 97:e11230. [PMID: 29995755 PMCID: PMC6076158 DOI: 10.1097/md.0000000000011230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Although established guidelines currently recommend the use of the CHA2DS2-VASc score for evaluating embolic risk in AF patients, few studies have evaluated the use of the CHA2DS2-VASc score for predicting cardiovascular outcomes in patients with acute myocardial infarction (AMI). The aim of this study was to determine whether CHA2DS2-VASc score is a predictor of a major adverse cardiocerebral vascular event (MACCE) in AMI patients.This study analyzed data in the Taiwan National Health Insurance Research Database from January 2008 to December 2012. Cardiovascular outcomes were analyzed according to the baseline characteristics, presence of AF, and CHA2DS2-VASc score.Twenty nine thousand four hundred fifty-two patients with non-fatal AMI, 1171 patients (8.3%) were with AF. The Cox regress model showed with the exception of women sex and peripheral artery disease, all the baseline characteristics considered risks in CHA2DS2-VASc scores were independently associated with the increased incidence of MACCE within 1 year after AMI. A CHA2DS2-VASc score of <5 had negative predictive values of 93.37% for recurrent MI, 98.45% for stroke, 94.86% for HF admission, 98.83% for mortality, and 87.80% for MACCE. Regardless of the presence of AF, the CHA2DS2-VASc score was correlated with 1-year MACCE.The CHA2DS2-VASc score was correlated with 1-year MACCE in AMI patients who were discharge alive. The CHA2DS2-VASc score is useful predictor for 1 year MACCE in patients with AMI.
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Affiliation(s)
- Chen-Yu Li
- Clinical Informatics and Medical Statistics Research Center
- Foreign Language and International Trade School, Wenzhou Business College, Wenzhou, China
| | - Chee-Jen Chang
- Clinical Informatics and Medical Statistics Research Center
- Graduate Institute of Clinical Medical Science
- Research Services Center For Health Information Resource Center for Clinical Research, Chang Gung University, Taoyuan
- Chang Gung University College of Medicine
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Cheng-Jui Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Chien-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Cheng-I Cheng
- Chang Gung University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
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de Waha S, Schoene K, Fuernau G, Desch S, Eitel I, Pöss J, Meyer-Saraei R, Eitel C, Tilz R, Schuler G, Werdan K, Schneider S, Ouarrak T, Zeymer U, Thiele H. Prognostic impact of atrial fibrillation in cardiogenic shock complicating acute myocardial infarction: a substudy of the IABP-SHOCK II trial. Clin Res Cardiol 2017; 107:233-240. [DOI: 10.1007/s00392-017-1175-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/03/2017] [Indexed: 11/29/2022]
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Petrenas A, Marozas V, Sološenko A, Kubilius R, Skibarkiene J, Oster J, Sörnmo L. Electrocardiogram modeling during paroxysmal atrial fibrillation: application to the detection of brief episodes. Physiol Meas 2017; 38:2058-2080. [PMID: 28980979 DOI: 10.1088/1361-6579/aa9153] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A model for simulating multi-lead ECG signals during paroxysmal atrial fibrillation (AF) is proposed. SIGNIFICANCE The model is of particular significance when evaluating detection performance in the presence of brief AF episodes, especially since annotated databases with such episodes are lacking. APPROACH The proposed model accounts for important characteristics such as switching between sinus rhythm and AF, varying P-wave morphology, repetition rate of f-waves, presence of atrial premature beats, and various types of noise. MAIN RESULTS Two expert cardiologists assessed the realism of simulated signals relative to real ECG signals, both in sinus rhythm and AF. The cardiologists identified the correct rhythm in all cases, and considered two-thirds of the simulated signals as realistic. The proposed model was also investigated by evaluating the performance of two AF detectors which explored either rhythm only or both rhythm and morphology. The results show that detection performance is strongly dependent on AF episode duration, and, consequently, demonstrate that the model can play a significant role in the investigation of detector properties.
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Affiliation(s)
- Andrius Petrenas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
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37
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Zhu W, Guo L, Liu F, Wan R, Shen Y, Lip GYH, Hong K. Efficacy and safety of triple versus dual antithrombotic therapy in atrial fibrillation and ischemic heart disease: a systematic review and meta-analysis. Oncotarget 2017; 8:81154-81166. [PMID: 29113375 PMCID: PMC5655270 DOI: 10.18632/oncotarget.20870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/26/2017] [Indexed: 12/18/2022] Open
Abstract
The optimal antithrombotic regimen for patients with atrial fibrillation and ischemic heart disease remains unclear. Therefore, we aimed to compare the efficacy and safety of triple therapy (TT [an anticoagulant and 2 antiplatelet drugs]) with dual therapy (DAPT [2 antiplatelet drugs] or DT [an anticoagulant and a single antiplatelet drug]) in patients with atrial fibrillation and ischemic heart disease. We systematically searched the Cochrane Library, PubMed and Embase databases for all relevant studies up to August 2017. The overall risk estimates were calculated using the random-effects model. A total of 17 observational studies were included. Regarding the efficacy outcomes, no differences were observed between the triple therapy and the dual therapy for all-cause death, cardiovascular death, or thrombotic complications (i.e., acute coronary syndrome, stent thrombosis, thromboembolism/stroke, and major adverse cardiac and cerebrovascular events). Regarding the safety outcomes, compared with DAPT, TT was associated with increased risks of major bleeding (a relative risk of 1.96 [1.40–2.74]), minor bleeding (1.69 [1.06–2.71]) and overall bleeding (1.80 [1.23–2.64]). Compared wtih DT, TT was associated with a greater risk of major bleeding (1.65 [1.23–2.21]), but rates of minor bleeding (0.99 [0.56–1.77]) and overall bleeding (1.14 [0.76–1.71]) were similar. Overall, TT confers an increased hazard of major bleeding with no thromboembolic protection compared with dual therapy in patients with atrial fibrillation and ischemic heart disease.
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Affiliation(s)
- Wengen Zhu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Linjuan Guo
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Fadi Liu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Rong Wan
- Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, China
| | - Yang Shen
- Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, China
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, China
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38
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Beiert T, Tiyerili V, Knappe V, Effelsberg V, Linhart M, Stöckigt F, Klein S, Schierwagen R, Trebicka J, Nickenig G, Schrickel JW, Andrié RP. Relaxin reduces susceptibility to post-infarct atrial fibrillation in mice due to anti-fibrotic and anti-inflammatory properties. Biochem Biophys Res Commun 2017. [DOI: 10.1016/j.bbrc.2017.06.091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Pareek M, Bhatt DL, Ten Berg JM, Kristensen SD, Grove EL. Antithrombotic strategies for preventing long-term major adverse cardiovascular events in patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention. Expert Opin Pharmacother 2017; 18:875-883. [DOI: 10.1080/14656566.2017.1329822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Manan Pareek
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Jürrien M. Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Steen D. Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Erik L. Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Dézsi CA, Dézsi BB, Dézsi DA. Antithrombotic treatment in anticoagulated atrial fibrillation patients undergoing percutaneous coronary intervention. Eur J Intern Med 2017; 40:1-7. [PMID: 28065663 DOI: 10.1016/j.ejim.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/29/2023]
Abstract
UNLABELLED Coronary artery disease coexists in a clinically relevant number of patients with atrial fibrillation and it often requires percutaneous coronary intervention. These patients represent a particular challenge for clinicians in terms of antithrombotic management. They require combined antiplatelet-anticoagulant therapy to reduce the risk of recurrent ischemic cardiac events and stroke; however, this antithrombotic strategy is associated with an increased risk of bleeding complications. In the absence of randomized, controlled clinical trials, the majority of current recommendations rely on the results of cohort studies, meta-analyses, post-hoc analyses and subgroup analyses of large, phase III studies. Based on the available evidence, the present review discusses the optimal antithrombotic strategy for patients receiving chronic anticoagulant therapy due to atrial fibrillation who require antiplatelet treatment after acute coronary syndrome and/or percutaneous coronary intervention, and discusses the issue of dental procedures. The correct planning of therapy significantly reduces the risk of bleeding complications and thromboembolic events. KEY MESSAGES In order to reduce the occurrence of recurrent cardiac ischemic events and stroke, anticoagulated patients with acute coronary syndrome and/or percutaneous coronary intervention require a combination of therapies including anticoagulants and antiplatelet drugs. Using the newest optimal combination of therapeutic strategies reduces the risk of haemorrhagic complications.
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Affiliation(s)
- Csaba András Dézsi
- Petz Aladár County Teaching Hospital, Department of Cardiology, 2-4 Vasvári P. str., 9024 Győr, Hungary.
| | - Balázs Bence Dézsi
- Private Practice, SolyDent Dentist's Office, 24/b. Kálvária str., 9024 Győr, Hungary
| | - Döme András Dézsi
- Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyógy sq., 8230 Balatonfüred, Hungary
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Borghi C, Omboni S, Novo S, Vinereanu D, Ambrosio G, Ambrosioni E. Zofenopril and ramipril in patients with left ventricular systolic dysfunction after acute myocardial infarction: A propensity analysis of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) 4 study. J Renin Angiotensin Aldosterone Syst 2016; 17:17/4/1470320316656480. [PMID: 27708111 PMCID: PMC5843868 DOI: 10.1177/1470320316656480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/30/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction: This was a propensity score analysis of the prospective, randomized, double-blind Survival of Myocardial Infarction Long-term Evaluation (SMILE) 4 study in which one-year treatment with zofenopril 60 mg plus acetylsalicylic acid (ASA) 100 mg gave superior results compared to ramipril 10 mg plus ASA in terms of death or hospitalization for cardiovascular causes in patients with acute myocardial infarction (AMI) complicated by left ventricular dysfunction (LVD). Materials and methods: A total of 716 patients of the intention-to-treat population were divided into homogeneous propensity quintiles (Q) using a logistic regression model (QI: best risk profile; QV: worst risk profile). Results: Treatment was associated with a similar low rate of major cardiovascular events in any Q. However, the efficacy of zofenopril was better than that of ramipril in QII, QV, and particularly QIII (odds ratio (OR) and 95% confidence interval: 0.43 (0.21–0.87), p<0.05]. This result was primarily attributed to a decrease in the risk of cardiovascular hospitalization, particularly striking in the QIII (OR: 0.40, 0.19-0.85; p<0.05). Mortality rate did not significantly differ between the two treatments in any Q. Conclusions: In the SMILE-4 study the propensity analysis confirmed the efficacy of zofenopril in the prevention of long-term cardiovascular outcomes irrespective of the cardiovascular risk profile of post-AMI patients.
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Affiliation(s)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Italy
| | | | - Dragos Vinereanu
- Cardiology, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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42
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Hillas G, Perlikos F, Tzanakis N. Acute exacerbation of COPD: is it the "stroke of the lungs"? Int J Chron Obstruct Pulmon Dis 2016; 11:1579-86. [PMID: 27471380 PMCID: PMC4948693 DOI: 10.2147/copd.s106160] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the top five major causes of morbidity and mortality worldwide. Despite worldwide health care efforts, costs, and medical research, COPD figures demonstrate a continuously increasing tendency in mortality. This is contrary to other top causes of death, such as neoplasm, accidents, and cardiovascular disease. A major factor affecting COPD-related mortality is the acute exacerbation of COPD (AECOPD). Exacerbations and comorbidities contribute to the overall severity in individual patients. Despite the underestimation by the physicians and the patients themselves, AECOPD is a really devastating event during the course of the disease, similar to acute myocardial infarction in patients suffering from coronary heart disease. In this review, we focus on the evidence that supports the claim that AECOPD is the “stroke of the lungs”. AECOPD can be viewed as: a Semicolon or disease’s full-stop period, Triggering a catastrophic cascade, usually a Relapsing and Overwhelming event, acting as a Killer, needing Emergent treatment.
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Affiliation(s)
- Georgios Hillas
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens
| | - Fotis Perlikos
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
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43
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Kea B, Alligood T, Manning V, Raitt M. A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:107-118. [PMID: 28090403 DOI: 10.1007/s40138-016-0105-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered by clinicians. Clinical decision-making focuses on reducing ischemic stroke risk in AF patients; however, AF is also associated with an increased risk of acute coronary syndromes (ACS). Patients with ACS and concurrent AF are less likely to receive appropriate therapies and more likely to experience adverse outcomes than ACS patients in sinus rhythm (SR). Clinicians may be able to stratify ACS patients at increased risk of AF development based on clinical characteristics. Evidence supporting specific therapeutic options for prevention of ACS in AF patients or for prevention of AF in ACS patients is limited, however there is some evidence of differing effects among oral anticoagulant regimens in these populations. Investigations of the relationship of AF with the full spectrum of ACS are not well described and should be the focus of future research.
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Affiliation(s)
- Bory Kea
- Assistant Professor, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Mailcode CR114, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, 503-494-4430 (p), 503-494-8237 (f)
| | - Tahroma Alligood
- Research Associate, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Doctoral Student, Department of Public Health & Preventive Medicine, OHSU/PSU School of Public Health, Mailcode CR114, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, 503-494-4566
| | - Vincent Manning
- Medical Student (4 Year), Oregon Health & Science University School of Medicine, 4460 SW Scholls Ferry Road, Apt. #3, Portland, OR 97225
| | - Merritt Raitt
- Professor of Medicine, Oregon Health and Science University, Director Electrophysiology Service, VA Health Center System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, 503-220-8262
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44
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De Caterina R, Goto S. Targeting thrombin long-term after an acute coronary syndrome: Opportunities and challenges. Vascul Pharmacol 2016; 81:1-14. [DOI: 10.1016/j.vph.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/06/2016] [Accepted: 03/13/2016] [Indexed: 01/21/2023]
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45
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Massera D, Wang D, Vorchheimer DA, Negassa A, Garcia MJ. Increased risk of stroke and mortality following new-onset atrial fibrillation during hospitalization. Europace 2016; 19:929-936. [DOI: 10.1093/europace/euw110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/26/2016] [Indexed: 11/13/2022] Open
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New-onset versus prior history of atrial fibrillation: Outcomes from the AFFIRM trial. Am Heart J 2015; 170:156-63, 163.e1. [PMID: 26093877 DOI: 10.1016/j.ahj.2015.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/12/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are limited data on prognosis and outcomes of patients with new-onset atrial fibrillation (AF) compared with those with a prior history of AF. METHODS AND RESULTS We conducted a comparison of these 2 groups in the AFFIRM trial. New-onset AF was the qualifying arrhythmia in 1,391 patients (34%). Compared with patients with prior history of AF, patients with new-onset AF were more likely to have a history of heart failure. There was no mortality difference between rate control (RaC) and rhythm control (RhC) among patients with new-onset AF (17% vs 20%, P = .152). In the univariate model, new-onset AF was associated with increased risk of mortality compared with history of prior AF (RaC unadjusted hazard ratio [HR] 1.36 [P = .010], RhC unadjusted HR 1.39 [P = .003]). However, after multivariate adjustments, new-onset AF did not carry an increased risk of mortality (RaC adjusted HR 1.14 [P = .370], RhC adjusted HR 1.16 [P = .248]). Subjects with new-onset AF randomized to the RhC arm were more likely to remain in normal sinus rhythm at follow-up (adjusted HR 0.79, P = .012) compared with patients with prior history of AF. CONCLUSIONS In a multivariable analysis adjusting for confounders, new-onset AF was not associated with increased mortality compared with prior history of AF regardless of the treatment strategy. Patients with new-onset AF treated with the rhythm control strategy were more likely to remain in normal sinus rhythm on follow-up.
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48
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Bang CN, Okin PM. The long and short of the PR-interval: relation to cardiovascular outcome in patients with coronary heart disease. Europace 2015; 17:838-9. [DOI: 10.1093/europace/euu284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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49
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Stamboul K, Zeller M, Fauchier L, Gudjoncik A, Buffet P, Garnier F, Guenancia C, Lorgis L, Beer JC, Touzery C, Cottin Y. Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up. Heart 2015; 101:864-9. [PMID: 25903836 DOI: 10.1136/heartjnl-2014-307253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/26/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in patients experiencing silent AF in AMI. METHODS All consecutive patients with AMI who were prospectively analysed by CEM during the first 48 h after admission and who survived at hospital discharge were included. Silent AF was defined as asymptomatic episodes lasting at least 30 s. Patients were followed up at 1 year for cardiovascular (CV) outcomes. RESULTS Among the 737 patients analysed, 106 (14%) developed silent AF and 32 (4%) symptomatic AF. Compared with the no-AF group, patients with silent AF were markedly older (79 vs 62 years, p<0.001), more frequently hypertensive (71% vs 49%, p<0.001) and less likely to be smokers (23% vs 37%, p<0.001). Also, they were more likely to have impaired LVEF (50% vs 55%, p<0.001). Risk factors in patients with silent AF were similar to those in patients with symptomatic AF. However, a history of stroke or AF was less frequent in silent AF than in symptomatic-AF patients (10% vs 25% and 10% vs 38%, respectively). At 1 year, CV events including hospitalisation for heart failure (HF) and CV mortality were markedly higher in silent-AF patients than in no-AF patients (6.6% vs 1.3% and 5.7% vs 2.0%, p<0.001, respectively). CONCLUSIONS Our large prospective study showed for the first time that silent AF is associated with worse 1-year prognosis after AMI. Systematic screening and specific management should be investigated in order to improve outcomes of patients after AMI.
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Affiliation(s)
- Karim Stamboul
- Cardiology Department, University Hospital, Dijon, France
| | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, University of Burgundy, Dijon, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau University Hospital and François Rabelais University, Tours, France
| | | | | | - Fabien Garnier
- Cardiology Department, University Hospital, Dijon, France
| | | | - Luc Lorgis
- Cardiology Department, University Hospital, Dijon, France
| | | | - Claude Touzery
- Cardiology Department, University Hospital, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France
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50
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Lip GY, Windecker S, Huber K, Kirchhof P, Marin F, Ten Berg JM, Haeusler KG, Boriani G, Capodanno D, Gilard M, Zeymer U, Lane D, Storey RF, Bueno H, Collet JP, Fauchier L, Halvorsen S, Lettino M, Morais J, Mueller C, Potpara TS, Rasmussen LH, Rubboli A, Tamargo J, Valgimigli M, Zamorano JL. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 2014; 35:3155-79. [DOI: 10.1093/eurheartj/ehu298] [Citation(s) in RCA: 432] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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