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Yang J, Su B, Liao R, Wang J, Bo S. Synthesis of pyrrolo[3,2-d]pyrimidineone derivatives as novel FXa inhibitors. Bioorg Med Chem Lett 2023; 80:129127. [PMID: 36634753 DOI: 10.1016/j.bmcl.2023.129127] [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: 11/26/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/10/2023]
Abstract
A series of pyrrolo[3,2-d]pyrimidineone compounds have been designed and synthesized as novel FXa inhibitors. Bioassay of the tested compounds showed moderate to excellent anticoagulant potency in vitro. Further FXa inhibitory and bioactivity evaluation in rats, the FeCl3-induced venous thrombosis model, showed that the compound 17a has good FXa inhibitory activity (IC50 = 1.57 nM) and in vivo antithrombotic potency. The anticoagulant effects of compound 17a were dose dependent whether in vitro or in vivo. The results further confirmed our hypothesis that the large conjugated structure is an ideal skeleton binding FXa.
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Affiliation(s)
- Jiabin Yang
- Nanjing Zhongrui Pharmaceutical Co., Ltd, Nanjing, Jiangsu 211100, PR China
| | - Bolang Su
- Nanjing Zhongrui Pharmaceutical Co., Ltd, Nanjing, Jiangsu 211100, PR China
| | - Ruizhu Liao
- Nanjing Zhongrui Pharmaceutical Co., Ltd, Nanjing, Jiangsu 211100, PR China
| | - Jinrui Wang
- School of Medicine, Xuchang University, Xuchang, Henan 461000, PR China
| | - Shuyu Bo
- Department of Geriatrics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, PR China.
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2
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Wibawa K, Dewangga R, Nastiti KS, Syah PA, Suhendiwijaya S, Ariffudin Y. Prior statin use and the incidence of in-hospital arrhythmia in acute coronary syndrome: A systematic review and meta-analysis. Indian Heart J 2023; 75:9-16. [PMID: 36642406 PMCID: PMC9986741 DOI: 10.1016/j.ihj.2023.01.004] [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: 10/01/2022] [Revised: 12/07/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The benefit of prior statin use to reduce the incidence of arrhythmia in acute coronary syndrome (ACS) is still a matter of debate. Statins have multiple pleiotropic effects, which may reduce the incidence of in-hospital arrhythmia. A systematic review and meta-analysis were performed to evaluate prior statin use and the incidence of in-hospital arrhythmia in ACS. METHODS This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We performed a literature search through Pubmed, Proquest, EBSCOhost, and Clinicaltrial.gov. A random-effect model was used due to moderate heterogeneity. Quality assessment was performed using Newcastle Ottawa Scale. Sensitivity analysis was performed by using leave one or two out method. PROSPERO registration number: CRD42022336402. RESULTS Nine eligible studies consisting of 86,795 patients were included. A total of 22,130 (25.5%) patients were in statin use before the index ACS event. The prevalence of old myocardial infarction, heart failure, hypertension, diabetes mellitus, and chronic renal failure and concomitant treatment with aspirin, clopidogrel, and beta blocker was higher in the prior statin group compared to no previous statin. Overall, prior statin use was associated with a significantly lower incidence of in-hospital arrhythmia during ACS compared to no previous statin (OR 0.60; 95% CI 0.49-0.72; P < 0.00001; I2 = 54%, P-heterogeneity = 0.03). In subgroup analysis, previous statin use reduced the incidence of atrial fibrillation or atrial flutter (OR 0.64; 95% CI 0.43-0.95; P = 0.03; I2 = 73%, P-heterogeneity = 0.01) and ventricular tachycardia or ventricular fibrillation (OR 0.57; 95% CI 0.49-0.65; P < 0.00001; I2 = 8%, P-heterogeneity = 0.35). CONCLUSIONS Based on aggregate patient data, prior statin use may reduce the incidence of in-hospital arrhythmia during ACS, particularly atrial fibrillation or atrial flutter and ventricular tachycardia or ventricular fibrillation.
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Affiliation(s)
- Kevin Wibawa
- Gunung Jati General Hospital, Cirebon, West Java, Indonesia.
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Wang Q, Huai W, Ye X, Pan Y, Yang X, Chen M, Ma QB, Gao Y, Zhang Y. Circulating plasma galectin-3 predicts new-onset atrial fibrillation in patients after acute myocardial infarction during hospitalization. BMC Cardiovasc Disord 2022; 22:392. [PMID: 36057558 PMCID: PMC9440583 DOI: 10.1186/s12872-022-02827-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background New-onset atrial fibrillation (NOAF) is a common complication in patients with acute myocardial infarction (AMI) during hospitalization. Galectin-3 (Gal-3) is a novel inflammation marker that is significantly associated with AF. The association between post-AMI NOAF and Gal-3 during hospitalization is yet unclear. Objective The present study aimed to investigate the predictive value of plasma Gal-3 for post-AMI NOAF. Methods A total of 217 consecutive patients admitted with AMI were included in this retrospective study. Peripheral venous blood samples were obtained within 24 h after admission and plasma Gal-3 concentrations were measured. Results Post-AMI NOAF occurred in 18 patients in this study. Patients with NOAF were older (p < 0.001) than those without. A higher level of the peak brain natriuretic peptide (BNP) (p < 0.001) and Gal-3 (p < 0.001) and a lower low-density lipoprotein cholesterol level (LDL-C) (p = 0.030), and an estimated glomerular filtration rate (e-GFR) (p = 0.030) were recorded in patients with post-AMI NOAF. Echocardiographic information revealed that patients with NOAF had a significantly decreased left ventricular eject fraction (LVEF) (p < 0.001) and an increased left atrial diameter (LAD) (p = 0.004) than those without NOAF. The receiver operating characteristic (ROC) curve analysis revealed a significantly higher value of plasma Gal-3 in the diagnosis of NOAF for patients with AMI during hospitalization (area under the curve (p < 0.001), with a sensitivity of 72.22% and a specificity of 72.22%, respectively. Multivariate logistic regression model analysis indicated that age (p = 0.045), plasma Gal-3 (p = 0.018), and LAD (p = 0.014) were independent predictors of post-MI NOAF. Conclusions Plasma Gal-3 concentration is an independent predictor of post-MI NOAF.
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Affiliation(s)
- Qianhui Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Wei Huai
- Emergency Department, Third Clinical Medical College, Peking University, Beijing, 100191, China
| | - Xiaoguang Ye
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Yuxia Pan
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Xinchun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Mulei Chen
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Qing-Bian Ma
- Emergency Department, Third Clinical Medical College, Peking University, Beijing, 100191, China
| | - Yuanfeng Gao
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
| | - Yuan Zhang
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
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Santos H, Santos M, Almeida I, Paula SB, Almeida S, Chin J, Almeida L. Early and late new-onset of atrial fibrillation in acute coronary syndromes: Their differences in mortality and cardiac event. J Arrhythm 2022; 38:299-306. [PMID: 35785394 PMCID: PMC9237295 DOI: 10.1002/joa3.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background In a stressful situation like acute coronary syndrome (ACS), the occurrence of the first episode of atrial fibrillation is more frequent. The impact of the timing occurrence of AF new-onset (nAF) in the setting of ACS is still debatable. Methods Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry, including 29 851 patients admitted for ACS between 1/10/2010 and 4/09/2019. The group with early nAF - nAF in the first 48 h of hospitalization; and late nAF - patients with nAF after the first 48 h of in-hospital admission. Results New-onset AF was identified in 1067 patients, nonetheless, just 38.1% had late nAF. The group with late nAF presented more cardiovascular comorbidities and worse left ventricular ejection fraction. Late nAF patients received more anti-arrhythmic therapy, and early nAF had a higher beta-block prescription. Early nAF had higher rates of in-hospital complications, on the other hand, late nAF group exhibited more mortality and readmission at one year follow-up. Multiple logistic regression revealed that symptoms onset to the first medical contact time, admission hemoglobin <12 g/dl, right bundle branch block at admission, and diuretic therapy during the hospitalization for ACS were predictors of late nAF in ACS. Conclusions The ACS population could be divided by the timing of nAF occurrence into the two groups with different characteristics, therapeutic approaches, and outcomes. Late nAF patients had a worse prognosis at 1 year follow-up, however, the early nAF group had more major adverse cardiac events during the hospitalization for ACS.
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Affiliation(s)
- Helder Santos
- Serviço de CardiologiaCentro Hospitalar Barreiro‐Montijo EPEBarreiroPortugal
| | - Mariana Santos
- Serviço de CardiologiaCentro Hospitalar Barreiro‐Montijo EPEBarreiroPortugal
| | - Inês Almeida
- Serviço de CardiologiaCentro Hospitalar Barreiro‐Montijo EPEBarreiroPortugal
| | - Sofia B. Paula
- Serviço de CardiologiaCentro Hospitalar Barreiro‐Montijo EPEBarreiroPortugal
| | - Samuel Almeida
- Serviço de CardiologiaCentro Hospitalar Barreiro‐Montijo EPEBarreiroPortugal
| | - Joana Chin
- Serviço de CardiologiaCentro Hospitalar Barreiro‐Montijo EPEBarreiroPortugal
| | - Lurdes Almeida
- Serviço de CardiologiaCentro Hospitalar Barreiro‐Montijo EPEBarreiroPortugal
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Jamal S, Ijaz SH, Minhas AMK, Kichloo A, Khan MZ, Albosta M, Aljadah M, Banga S, Baloch ZQ, Aboud H, Haji AQ, Sheikh A, Kanjwal K. Outcomes of Hospitalizations with Acute Respiratory Distress Syndrome with and without Atrial Fibrillation - Analyses from the National Inpatient Sample (2004-2014). Am J Med Sci 2022; 364:289-295. [DOI: 10.1016/j.amjms.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/17/2021] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
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Yi JE, Seo SM, Lim S, Choo EH, Choi IJ, Lee KY, Hwang BH, Kim CJ, Park MW, Kim DB, Her SH, Lee JM, Park CS, Kim PJ, Kim HY, Yoo KD, Jeon DS, Chung WS, Jeong MH, Ahn Y, Chang K. Gender Differences in the Impact of New-Onset Atrial Fibrillation on Long-Term Risk of Ischemic Stroke after Acute Myocardial Infarction. J Clin Med 2021; 10:jcm10215141. [PMID: 34768661 PMCID: PMC8584956 DOI: 10.3390/jcm10215141] [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: 10/11/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) has been identified as a major risk factor for mortality after acute coronary syndrome (ACS). However, the long-term risk of ischemic stroke associated with new-onset atrial fibrillation (NOAF) in ACS remains controversial, and its gender-specific association is unknown. METHODS We analyzed the data of 10,137 ACS survivors included in a multicenter, prospective registry for Korean patients with acute myocardial infarction (AMI) between January 2004 and August 2014. Subjects were categorized into three groups (non-AF vs. NOAF vs. previous AF) based on medical history and electrocardiographic evidence of AF, either at admission or during hospitalization. RESULTS Among the total study population (72.3% men), 370 patients (3.6%) had NOAF and 130 (1.3%) had previous AF. During a median follow-up of 61 months (interquartile range, 38.8 to 89.3 months), 245 (2.4%) patients (218 (2.3%) non-AF vs. 15 (4.1%) NOAF vs. 12 (9.2%) previous AF, p < 0.001) experienced ischemic stroke. After adjustment for confounding variables, both NOAF (adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09-3.24, p = 0.024) and previous AF (adjusted HR 4.00, 95% CI 2.03-7.87, p < 0.001), along with older age, diabetes, current smoker, and previous stroke were independent risk factors of ischemic stroke. In the gender-stratified analysis, men with previous AF but not NOAF had a significantly higher risk of ischemic stroke (adjusted HR 4.14, 95% CI 1.79-9.55, p = 0.001) than those without AF. In women, NOAF (adjusted HR 2.54, 95% CI 1.21-5.35, p = 0.014) as well as previous AF (adjusted HR 3.72, 95% CI 1.16-11.96, p = 0.028) was a strong predictor of ischemic stroke, and the predictive value was comparable to that of previous AF among patients with a CHA2DS2-VASc score ≥ 2. CONCLUSIONS Both NOAF and previous AF were associated with ischemic stroke after AMI, but the impact of NOAF as a risk factor of ischemic stroke was significant only in women.
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Affiliation(s)
- Jeong-Eun Yi
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
| | - Suk-Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
- Correspondence: ; Tel.: +82-2-2030-2599
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Ik-Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (I.-J.C.); (D.-S.J.)
| | - Kwan-Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Chan-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-B.K.); (H.-Y.K.)
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.H.); (K.-D.Y.)
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Pum-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
| | - Hee-Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-B.K.); (H.-Y.K.)
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.H.); (K.-D.Y.)
| | - Doo-Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (I.-J.C.); (D.-S.J.)
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Myung-Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61748, Korea; (M.-H.J.); (Y.A.)
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61748, Korea; (M.-H.J.); (Y.A.)
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
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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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De Luca L, Rubboli A, Bolognese L, Gonzini L, Urbinati S, Murrone A, Scotto di Uccio F, Ferrari F, Lucà F, Caldarola P, Lucci D, Gabrielli D, Di Lenarda A, Gulizia MM. Antithrombotic management of patients with acute coronary syndrome and atrial fibrillation undergoing coronary stenting: a prospective, observational, nationwide study. BMJ Open 2020; 10:e041044. [PMID: 33371033 PMCID: PMC7757435 DOI: 10.1136/bmjopen-2020-041044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/27/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess current management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) undergoing coronary stenting. DESIGN Non-interventional, prospective, nationwide study. SETTING 76 private or public cardiology centres in Italy. PARTICIPANTS Patients with ACS with concomitant AF undergoing percutaneous coronary intervention (PCI). PRIMARY AND SECONDARY OUTCOME MEASURES To obtain accurate and up-to-date information on pharmacological management of patients with AF admitted for an ACS and undergoing PCI with stent implantation. RESULTS Over a 12-month period, 598 consecutive patients were enrolled: 48.8% with AF at hospital admission and 51.2% developing AF during hospitalisation. At discharge, a triple antithrombotic therapy (TAT) was prescribed in 64.8%, dual antiplatelet therapy (DAPT) in 25.7% and dual antithrombotic therapy (DAT) in 8.8% of patients. Among patients with AF at admission, TAT and DAT were more frequently prescribed compared with patients with new-onset AF (76.3% vs 53.8% and 12.5% vs 5.3%, respectively; both p<0.0001), while a DAPT was less often used (11.2% vs 39.5%; p<0.0001). At multivariable analysis, a major bleeding event (OR: 5.40; 95% CI: 2.42 to 12.05; p<0.0001) and malignancy (OR: 5.11; 95% CI: 1.77 to 14.78; p=0.003) resulted the most important independent predictors of DAT prescription. CONCLUSIONS In this contemporary registry of patients with ACS with AF treated with coronary stents, TAT still resulted as the antithrombotic strategy of choice, DAT was reserved for high bleeding risk and DAPT was mainly prescribed in those developing AF during hospitalisation. TRIAL REGISTRATION NUMBER NCT03656523.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Andrea Rubboli
- Division of Cardiology, S Maria delle Croci Hospital, Ravenna, Italy
| | - Leonardo Bolognese
- Department of Cardioneurovascular Sciences, S Donato Hospital, Arezzo, Italy
| | - Lucio Gonzini
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Stefano Urbinati
- Cardiology, Bellaria Carlo Alberto Pizzardi Hospital, Bologna, Italy
| | - Adriano Murrone
- Division of Cardiology, Città di Castello Hospital, Perugia, Italy
| | | | - Fabio Ferrari
- Division of Cardiology, AOS Luigi Gonzaga, Orbassano, Italy
| | - Fabiana Lucà
- Division of Cardiology, Large Metropolitan Hospital, Bianchi Melacrino Morelli Company, Reggio Calabria, Italy
| | | | - Donata Lucci
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | | | - Andrea Di Lenarda
- Division of Cardiology, Integrated University Health Authority of Trieste, Trieste, Italy
| | - Michele Massimo Gulizia
- Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy
- Heart Care Foundation, Firenze, Italy
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Liu L, Gan S, Li B, Ge X, Yu H, Zhou H. Fisetin Alleviates Atrial Inflammation, Remodeling, and Vulnerability to Atrial Fibrillation after Myocardial Infarction. Int Heart J 2019; 60:1398-1406. [DOI: 10.1536/ihj.19-131] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Liang Liu
- Department of Cardiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology
| | - Shouyi Gan
- Department of Cardiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology
| | - Bin Li
- Department of Cardiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology
| | - Xiong Ge
- Department of Cardiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology
| | - Hui Yu
- Department of Cardiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology
| | - Huiliang Zhou
- Department of Cardiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology
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Tekin Tak B, Ekizler FA, Ozcan Cetin EH, Tak S, Ozeke O, Cay S, Aras D. New-Onset Atrial Fibrillation During Acute Coronary Syndromes. Angiology 2019; 71:666. [PMID: 31763925 DOI: 10.1177/0003319719889483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bahar Tekin Tak
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | | | - Elif Hande Ozcan Cetin
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Sercan Tak
- Department of Cardiovascular Surgery, Health Sciences University, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
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Shiyovich A, Axelrod M, Gilutz H, Plakht Y. Early Versus Late New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Differences in Clinical Characteristics and Predictors. Angiology 2019; 70:921-928. [DOI: 10.1177/0003319719867542] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out “high risk” AMI population for more meticulous heart rate monitoring for NOAF.
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Affiliation(s)
- Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and “Sackler” Faculty of Medicine, Tel-Aviv University Israel, Tel Aviv-Yafo, Israel
| | - Michal Axelrod
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Harel Gilutz
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ygal Plakht
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, and Soroka University Medical Center, Beer-Sheva, Israel
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Atrial Fibrillation and Acute Myocardial Infarction – An Inflammation-Mediated Association. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2018. [DOI: 10.2478/jce-2018-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT
Atrial fibrillation (AF) is an increasingly widespread healthcare problem. AF can frequently present as a complication in acute coronary syndromes (ACS), especially in ST-elevation acute myocardial infarction (AMI), in which case it is the most frequent supraventricular rhythm disturbance with an estimated incidence of 6.8-21%. The presence of AF in ACS heralds worse outcomes in comparison to subjects in sinus rhythm, and several studies have shown that in AMI patients, both new-onset and pre-existing AF are associated with a higher risk of major adverse cardiovascular and cerebrovascular events during hospitalization. The cause of newonset AF in AMI is multifactorial. Although still incompletely understood, the mechanisms involved in the development of AF in acute myocardial ischemic events include the neurohormonal activation of the sympathetic nervous system that accompanies the AMI, ischemic involvement of the atrial myocytes, ventricular dysfunction, and atrial overload. The identification of patients at risk for AF is of great significance as it may lead to prompt therapeutic interventions and closer follow-up, thus improving prognosis and decreasing cardiovascular and cerebrovascular events. The present manuscript aims to summarize the current research findings related to new-onset AF in AMI patients, as well as the predictors and prognostic impact of this comorbid association.
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Galjautdinov1 GS, Gorelkin IV, Ibragimova KR, Sadriev RR. NEW-ONSET ATRIAL FIBRILLATION IN SETTINGS OF ACUTE CORONARY SYNDROME. CURRENT ISSUES. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-3-451-457] [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 review is focuses on new onset atrial fibrillation (AF) in conditions of acute coronary syndrome (ACS). Literature sources from PubMed and Scopus was used. AF is common in the general population and in the ACS population, at that new onset AF, and AF, which was by the time of ACS development are determined. Appearance of AF is more likely amongst the elderly patients with congestive heart failure, with signs of the hemodynamic instability and with the left atrium dilatation. It is well-known about the predictors of adverse outcome in ACS. According to some literature data new onset AF leads to worsening of prognosis, and in line with other sources a reason of its association with high level of mortality is due to the severity of ACS and appearance of AF is not independent predictor of death. The absence of subjective symptoms at the time of paroxysm of new onset AF does not allow estimating its duration and distinguishing between the new onset AF, persistent and constant AF. It is possible to trace the relationship between the myocardial ischemia and AF appearance. Inefficient reperfusion during percutaneous coronary intervention or thrombolytic therapy is accompanied by the onset of AF, on the contrary, when effective patency of coronary artery is achieved, AF appears significantly less often. New onset AF in ACS, in particular, accompanied by cardiogenic shock, requires emergency pharmacological or electrical cardioversion. In some cases, active cardioversion is not necessary, because of spontaneous cardiac rhythm conversion. In conclusions, it is necessary to point out, that ambiguity and multifactority of this problem demands investigation of arrhythmogenesis mechanisms and development of special risk stratification instruments for the new onset AF in ACS.
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The diosgenin prodrug nanoparticles with pH-responsive as a drug delivery system uniquely prevents thrombosis without increased bleeding risk. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:673-684. [DOI: 10.1016/j.nano.2017.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022]
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De Luca L, Casella G, Rubboli A, Gonzini L, Lucci D, Boccanelli A, Chiarella F, Di Chiara A, De Servi S, Di Lenarda A, Di Pasquale G, Savonitto S. Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation. Int J Cardiol 2017; 248:369-375. [DOI: 10.1016/j.ijcard.2017.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/15/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
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16
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Zeng RX, Chen MS, Lian BT, Liao PD, Zhang MZ. Left ventricular ejection fraction and left atrium diameter related to new-onset atrial fibrillation following acute myocardial infarction: a systematic review and meta-analysis. Oncotarget 2017; 8:81137-81144. [PMID: 29113373 PMCID: PMC5655268 DOI: 10.18632/oncotarget.20821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/23/2017] [Indexed: 01/16/2023] Open
Abstract
Background New-onset atrial fibrillation (NOAF) occurs frequently in patients with acute myocardial infarction (AMI), and is associated with increased subsequent cardiovascular mortality. However, only a few studies directly evaluated the relationship of left ventricular ejection fraction (LVEF) or left atrium diameter (LAD) and NOAF following AMI. Materials and Methods MEDLINE®, EMBASE® and the Cochrane Library were carried out to find studies until January 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of LVEF and LAD in the prediction of NOAF after AMI. We performed sensitivity analyses to explore the potential sources of heterogeneity. Statistical analyses were carried out using the Revman 5.3. Result We included 10 qualifying studies comprising a total of 708 patients with NOAF and 6785 controls. Overall, decreased LVEF and increased LAD levels had a significant positive association with NOAF in patients with AMI. The MD in the LVEF levels between the patients with and those without NOAF was −4.91 units (95% Cl: −5.70 to −4.12), test for overall effect z-score = 12.18 (p < 0.00001, I2 = 35%). Moreover, in a subgroup analysis, the MD for LAD and NOAF was 2.55 units (95% Cl: 1.91 to 3.19), test for overall effect z-score = 7.80 (p < 0.00001, I2 = 57%). Conclusions Our meta-analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI.
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Affiliation(s)
- Rui-Xiang Zeng
- Division of Chest Pain Center, Guangdong Provincial Hospital of Chinese Medicine, The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P.R. China
| | - Mao-Sheng Chen
- Division of Chest Pain Center, Guangdong Provincial Hospital of Chinese Medicine, The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P.R. China
| | - Bao-Tao Lian
- Division of Chest Pain Center, Guangdong Provincial Hospital of Chinese Medicine, The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P.R. China
| | - Peng-Da Liao
- Division of Chest Pain Center, Guangdong Provincial Hospital of Chinese Medicine, The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P.R. China
| | - Min-Zhou Zhang
- Division of Chest Pain Center, Guangdong Provincial Hospital of Chinese Medicine, The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P.R. China
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Wang Y, Sun X, Yang D, Guo Z, Fan X, Nie M, Zhang F, Liu Y, Li Y, Wang Y, Gong P, Liu Y. Design, synthesis, and structure–activity relationship of novel and effective apixaban derivatives as FXa inhibitors containing 1,2,4-triazole/pyrrole derivatives as P2 binding element. Bioorg Med Chem 2016; 24:5646-5661. [DOI: 10.1016/j.bmc.2016.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 11/24/2022]
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18
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Postoperative atrial fibrillation may be associated with other factors. Anatol J Cardiol 2016; 16:549-50. [PMID: 27389162 PMCID: PMC5331411 DOI: 10.14744/anatoljcardiol.2016.7084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wang W, Yuan J, Fu X, Meng F, Zhang S, Xu W, Xu Y, Huang C. Novel Anthranilamide-Based FXa Inhibitors: Drug Design, Synthesis and Biological Evaluation. Molecules 2016; 21:491. [PMID: 27089317 PMCID: PMC6274369 DOI: 10.3390/molecules21040491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/31/2016] [Accepted: 04/07/2016] [Indexed: 01/26/2023] Open
Abstract
Factor Xa (FXa) plays a significant role in the blood coagulation cascade and it has become a promising target for anticoagulation drugs. Three oral direct FXa inhibitors have been approved by the FDA for treating thrombotic diseases. By structure-activity relationship (SAR) analysis upon these FXa inhibitors, a series of novel anthranilamide-based FXa inhibitors were designed and synthesized. According to our study, compounds 1a, 1g and 1s displayed evident FXa inhibitory activity and excellent selectivity over thrombin in in vitro inhibition activities studies. Compounds 1g and 1s also exhibited pronounced anticoagulant activities in in vitro anticoagulant activity studies.
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Affiliation(s)
- Wenzhi Wang
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, China.
- Tianjin Key Laboratory of Molecular Design and Drug Discovery, Tianjin Institute of Pharmaceutical Research, Tianjin 300193, China.
| | - Jing Yuan
- Tianjin Key Laboratory of Molecular Design and Drug Discovery, Tianjin Institute of Pharmaceutical Research, Tianjin 300193, China.
| | - Xiaoli Fu
- Tianjin Key Laboratory of Molecular Design and Drug Discovery, Tianjin Institute of Pharmaceutical Research, Tianjin 300193, China.
| | - Fancui Meng
- Tianjin Key Laboratory of Molecular Design and Drug Discovery, Tianjin Institute of Pharmaceutical Research, Tianjin 300193, China.
| | - Shijun Zhang
- Tianjin Key Laboratory of Molecular Design and Drug Discovery, Tianjin Institute of Pharmaceutical Research, Tianjin 300193, China.
| | - Weiren Xu
- Tianjin Key Laboratory of Molecular Design and Drug Discovery, Tianjin Institute of Pharmaceutical Research, Tianjin 300193, China.
| | - Yongnan Xu
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, China.
| | - Changjiang Huang
- Tianjin Key Laboratory of Molecular Design and Drug Discovery, Tianjin Institute of Pharmaceutical Research, Tianjin 300193, China.
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Stamboul K, Fauchier L, Gudjoncik A, Buffet P, Garnier F, Lorgis L, Beer JC, Touzery C, Cottin Y. New insights into symptomatic or silent atrial fibrillation complicating acute myocardial infarction. Arch Cardiovasc Dis 2015; 108:598-605. [PMID: 26525569 DOI: 10.1016/j.acvd.2015.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 10/22/2022]
Abstract
Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF in the acute phase of myocardial infarction (MI) is a major event that can jeopardize the prognosis of patients in the short-, medium- and long-term, and is a powerful predictor of a poor prognosis after MI. The suspected mechanism underlying the excess mortality is the drop in coronary flow linked to the acceleration and arrhythmic nature of the left ventricular contractions, which reduce the left ventricular ejection fraction. The principal causes of AF-associated death after MI are linked to heart failure. Moreover, the excess risk of death in these heart failure patients has also been associated with the onset of sudden death. Whatever its form, AF has a major negative effect on patient prognosis. In recent studies, symptomatic AF was associated with inhospital mortality of 17.8%, to which can be added mortality at 1year of 18.8%. Surprisingly, silent AF also has a negative effect on the prognosis, as it is associated with an inhospital mortality rate of 10.4%, which remains high at 5.7% at 1year. Moreover, both forms of AF are independent predictors of mortality beyond traditional risk factors. The frequency and seriousness of silent AF in the short- and long-term, which were until recently rarely studied, raises the question of systematically screening for it in the acute phase of MI. Consequently, the use of continuous ECG monitoring could be a simple, effective and inexpensive solution to improve screening for AF, even though studies are still necessary to validate this strategy. Finally, complementary studies also effect of oxidative stress and endothelial dysfunction, which seem to play a major role in triggering this rhythm disorder.
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Affiliation(s)
- Karim Stamboul
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau University Hospital and François-Rabelais University, Tours, France
| | - Aurelie Gudjoncik
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | | | - Fabien Garnier
- Cardiology Department, University Hospital, Dijon, France
| | - Luc Lorgis
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France
| | | | - Claude Touzery
- Cardiology Department, University Hospital, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France.
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Yang J, Su G, Ren Y, Chen Y. Synthesis of 3,4-diaminobenzoyl derivatives as factor Xa inhibitors. Eur J Med Chem 2015; 101:41-51. [PMID: 26114810 DOI: 10.1016/j.ejmech.2015.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/22/2015] [Accepted: 06/05/2015] [Indexed: 02/05/2023]
Abstract
The coagulation factor Xa (FXa) plays a central role in the blood coagulation cascade. Recent studies have shown that FXa is a particularly attractive target for the development of oral antithrombotic agents. In view of the excellent pharmaceutical properties of 1,2-phenylenediamine-based FXa inhibitors and the reported structure-activity relationship (SAR) analysis of FXa inhibitors, we designed and synthesized a series of 3,4-diaminobenzoyl-based FXa inhibitors. Intensive SAR studies on this new series led to the discovery of 3,4-dimethoxyl substituted compound 7b. 7b is a highly potent, selective, direct FXa inhibitor with excellent in vivo antithrombotic activity.
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Affiliation(s)
- Jiabin Yang
- State Key Laboratory of Bioelectronics, School of Biological Science & Medical Engineering, Southeast University, Nanjing, Jiangsu 210096, PR China
| | - Guoqiang Su
- Nanjing Zhongrui Pharmaceutical Co., Ltd., Nanjing, Jiangsu 211100, PR China
| | - Yu Ren
- Nanjing Zhongrui Pharmaceutical Co., Ltd., Nanjing, Jiangsu 211100, PR China
| | - Yang Chen
- State Key Laboratory of Bioelectronics, School of Biological Science & Medical Engineering, Southeast University, Nanjing, Jiangsu 210096, PR China.
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Braga CG, Ramos V, Martins J, Arantes C, Abreu G, Vieira C, Salgado A, Gaspar A, Azevedo P, Álvares Pereira M, Magalhães S, Marques J. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Braga CG, Ramos V, Martins J, Arantes C, Abreu G, Vieira C, Salgado A, Gaspar A, Azevedo P, Álvares Pereira M, Magalhães S, Marques J. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. Rev Port Cardiol 2015; 34:403-10. [PMID: 26028489 DOI: 10.1016/j.repc.2015.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/01/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type - new-onset (nAF) or pre-existing (pAF) - is still controversial. OBJECTIVES To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS). METHODS We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.3% male) admitted to a single center over a three-year period, with a six-month follow-up. RESULTS AF rhythm was identified in 14.5% patients, of whom 71.4% presented nAF and 28.6% pAF. When AF types were compared, patients with nAF more frequently presented with ST-elevation ACS (p=0.003). Patients with pAF, in turn, were older (p=0.032), had greater left atrial diameter (p=0.001) and were less likely to have significant coronary lesions (p=0.034). Regarding therapeutic strategy, nAF patients were more often treated by rhythm control during hospital stay (p<0.001) and were less often anticoagulated at discharge (p=0.001). Compared with the population without AF, nAF was a predictor of death during hospital stay in univariate (p<0.001) and multivariate analysis (OR 2.67, p=0.047), but pAF was not. During follow-up, pAF was associated with higher mortality (p=0.014), while nAF patients presented only a trend towards worse prognosis. CONCLUSIONS AF during the acute phase of ACS appears to have a negative prognostic impact only in patients with nAF and not in those with pAF.
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Affiliation(s)
| | - Vítor Ramos
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Carina Arantes
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Glória Abreu
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | | | - António Gaspar
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Pedro Azevedo
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | | | - Jorge Marques
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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Yang J, Su G, Ren Y, Chen Y. Design, synthesis and evaluation of isoxazolo[5,4-d]pyrimidin-4(5H)-one derivatives as antithrombotic agents. Bioorg Med Chem Lett 2015; 25:492-5. [DOI: 10.1016/j.bmcl.2014.12.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/25/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
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Capodanno D, Angiolillo DJ. Management of antiplatelet and anticoagulant therapy in patients with atrial fibrillation in the setting of acute coronary syndromes or percutaneous coronary interventions. Circ Cardiovasc Interv 2014; 7:113-24. [PMID: 24550531 DOI: 10.1161/circinterventions.113.001150] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Davide Capodanno
- From the Cardio-thoraco-vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C.); and Department of Medicine, Division of Cardiology, University of Florida College of Medicine-Jacksonville, FL (D.C., D.J.A)
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Incidence and prognostic significance of silent atrial fibrillation in acute myocardial infarction. Int J Cardiol 2014; 174:611-7. [DOI: 10.1016/j.ijcard.2014.04.158] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/09/2014] [Accepted: 04/13/2014] [Indexed: 11/18/2022]
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Galvão Braga C, Ramos V, Vieira C, Martins J, Ribeiro S, Gaspar A, Salgado A, Azevedo P, Alvares Pereira M, Magalhães S, Correia A. New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis. Rev Port Cardiol 2014; 33:281-7. [PMID: 24931182 DOI: 10.1016/j.repc.2013.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 10/17/2013] [Accepted: 10/29/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION New-onset atrial fibrillation (AF) frequently complicates myocardial infarction, with an incidence of 6-21%. OBJECTIVE To assess the predictors and prognosis of new-onset AF during acute coronary syndromes (ACS). METHODS We performed a retrospective observational cohort study including 902 consecutive patients (mean age 64 years, 77.5% male) admitted to a single center over a two-year period, with a six-month follow-up. RESULTS AF rhythm was identified in 13.8% patients, of whom 73.3% presented new-onset AF and 26.8% pre-existing AF. New-onset AF was more frequent in older (p<0.001) and hypertensive patients (p=0.001) and in those with previous valvular heart disease (p<0.001) and coronary artery bypass grafting (p=0.049). During hospitalization, patients with new-onset AF more often had respiratory infection (p=0.002) and heart failure (p<0.001), and higher values of NT-proBNP (p=0.007) and peak creatinine (p=0.001). On echocardiography they had greater left atrial (LA) diameter (p<0.001) and more frequent significant mitral regurgitation (p<0.001) and left ventricular ejection fraction (LVEF) ≤40% (p<0.001) and were less likely to have significant coronary lesions (p=0.009) or to have undergone coronary revascularization (p<0.001). In multivariate analysis, age (OR 1.06, p=0.021), LVEF ≤40% (OR 4.91, p=0.002) and LA diameter (OR 1.14, p=0.008) remained independent predictors of new-onset AF. Together with age, diabetes and maximum Killip class, this arrhythmia was an independent predictor of overall mortality (OR 3.11, p=0.032). CONCLUSIONS Age, LVEF ≤40% and LA diameter are independent predictors of new-onset AF during ACS. This arrhythmia is associated with higher overall mortality (in-hospital and in follow-up).
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Affiliation(s)
| | - Vítor Ramos
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | | | - Sílvia Ribeiro
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - António Gaspar
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Pedro Azevedo
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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Galvão Braga C, Ramos V, Vieira C, Martins J, Ribeiro S, Gaspar A, Salgado A, Azevedo P, Álvares Pereira M, Magalhães S, Correia A. New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chen SY, Crivera C, Stokes M, Boulanger L, Schein J. Outcomes associated with comorbid atrial fibrillation and heart failure in Medicare beneficiaries with acute coronary syndrome. BMC Health Serv Res 2014; 14:80. [PMID: 24555428 PMCID: PMC3944778 DOI: 10.1186/1472-6963-14-80] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 01/07/2014] [Indexed: 11/17/2022] Open
Abstract
Background Atrial fibrillation (AF) and heart failure (HF) are both common comorbid conditions of elderly patients with acute coronary syndrome (ACS), but published data on their associated clinical and economic outcomes are limited. Methods Our study included patients from the Medicare Current Beneficiary Survey with an incident hospitalization for ACS between 03/01/2002 and 12/31/2006. Applying population weights, we identified 795 incident ACS patients, representing more than 2.5 million Medicare beneficiaries. Of this population, 13.1% had comorbid AF, and 22.9% had HF, which were identified from Medicare claims during the 6 months prior to the first ACS event (index date) Subsequent cardiovascular (CV) hospitalizations and mortality were compared using Kaplan–Meier curves. Cox proportional hazards regressions were used to estimate the relative risk of AF and HF on CV events and mortality. Healthcare costs were summarized for the calendar year in which the incident ACS event occurred. Results HF was associated with a 41% higher risk of mortality (HR = 1.41; 95% confidence interval [CI] 1.05–1.89). Both AF (HR = 1.46; 95% CI 1.14–1.87) and HF (HR = 1.61; 95% CI 1.26–2.06) were associated with higher risks of subsequent CV events. During the year of the incident ACS event, ACS patients with comorbid AF or HF had approximately $18,000 higher total healthcare costs than those without these comorbidities. Conclusion Using a nationally representative sample of Medicare beneficiaries, we observed a significantly higher clinical and economic burden of patients hospitalized for ACS with comorbid AF and HF compared with those without these conditions.
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Affiliation(s)
- Shih-Yin Chen
- Evidera, 430 Bedford Street Suite 300, Lexington, MA 02420, USA.
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Pathak R, Lau DH, Mahajan R, Sanders P. Structural and Functional Remodeling of the Left Atrium: Clinical and Therapeutic Implications for Atrial Fibrillation. J Atr Fibrillation 2013; 6:986. [PMID: 28496919 DOI: 10.4022/jafib.986] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. Despite advances in our understanding of the pathophysiology of this complex arrhythmia, current therapeutic options remain suboptimal. This review aimed to delineate the atrial structural and functional remodeling leading to the perpetuation of AF. We explored the complex changes seen in the atria in various substrates for AF and the therapeutic options available to prevent these changes or for reverse remodeling. Here we also highlighted the emerging role of aggressive risk factor management aimed at the arrhythmogenic atrial substrate to prevent or retard AF progression.
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Affiliation(s)
- Rajeev Pathak
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Alasady M, Shipp NJ, Brooks AG, Lim HS, Lau DH, Barlow D, Kuklik P, Worthley MI, Roberts-Thomson KC, Saint DA, Abhayaratna W, Sanders P. Myocardial infarction and atrial fibrillation: importance of atrial ischemia. Circ Arrhythm Electrophysiol 2013; 6:738-45. [PMID: 23873140 DOI: 10.1161/circep.113.000163] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is associated with the development of atrial fibrillation (AF). We aimed to characterize the atrial abnormalities because of MI and determine the role of ischemia to the AF substrate. METHODS AND RESULTS Forty-four sheep were studied. MI was induced by occlusion of the left circumflex artery (LCX) or left anterior descending artery (LAD). Excluding 11 with fatal arrhythmias, equal groups of animals (LCX; LAD; and sham-operated) underwent sequential electrophysiology study for 45 minutes to determine atrial effective refractory periods, conduction velocity, conduction heterogeneity index, and AF inducibility. Postmortem evaluation was performed with 2,3,5 triphenyl tetrazolium chloride staining. MI resulted in greater left ventricular dysfunction (P<0.05), LA pressure (P<0.0003), and reduction in atrial effective refractory periods (P<0.0001) compared with control. 2,3,5 triphenyl tetrazolium chloride staining demonstrated that the left circumflex artery, and not the LAD, group had atrial infarction. The left circumflex artery group demonstrated the following compared with the LAD or control groups: greater slowing in atrial conduction velocity (P<0.0001 and P<0.001); increased absolute range of conduction phase delay (P<0.001 and P<0.001); increased conduction heterogeneity index (P<0.0001 and P<0.001); greater AF vulnerability (P<0.05 for both); and longer AF duration (P<0.05 for both). LAD group had modest but significant slowing in conduction velocity (P<0.01) but no change in conduction heterogeneity index or AF duration compared with control. CONCLUSIONS Left ventricular infarction, which is known to result in atrial stretch, hemodynamic change, and neurohumoral activation, contributes partially to the atrial abnormalities in MI. Atrial ischemia/infarction results in greater atrial electrophysiological changes and propensity for AF forming the dominant substrate for AF in MI.
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Synthesis and structure–activity relationship of potent, selective and orally active anthranilamide-based factor Xa inhibitors: Application of weakly basic sulfoximine group as novel S4 binding element. Eur J Med Chem 2012; 58:136-52. [DOI: 10.1016/j.ejmech.2012.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 10/04/2012] [Accepted: 10/04/2012] [Indexed: 12/29/2022]
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Ad N, Henry L, Hunt S, Holmes SD. Do we increase the operative risk by adding the Cox Maze III procedure to aortic valve replacement and coronary artery bypass surgery? J Thorac Cardiovasc Surg 2012; 143:936-44. [PMID: 22244503 DOI: 10.1016/j.jtcvs.2011.12.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/20/2011] [Accepted: 12/14/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Niv Ad
- Inova Hear and Vascular Institute, Cardiac Surgery Research, Falls Church, VA 22042, USA.
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Hersi A, Alhabib KF, Alsheikh-Ali AA, Sulaiman K, Alfaleh HF, Alsaif S, Mahmeed WA, Asaad N, Haitham A, Al-Motarreb A, Suwaidi J, Shehab A. Prognostic Significance of Prevalent and Incident Atrial Fibrillation Among Patients Hospitalized with Acute Coronary Syndrome. Angiology 2011; 63:466-71. [DOI: 10.1177/0003319711427391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a paucity of data on atrial fibrillation (AF) complicating acute coronary syndrome (ACS) in Arabian Gulf countries. Thus, we assessed the incidence of AF in patients with ACS in these countries and examined the associated in-hospital, 30-day, and 1-year adverse outcomes. The population comprised 7930 patients enrolled in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Of 7930 patients with ACS, 217 (2.7%) had AF. Compared with patients without AF, patients with AF were less likely to be male (65.9 vs 79.1%) and were older (mean age 64.6 vs 56.6 years). Compared with patients without AF, in-hospital, 30-day, and 1-year mortality were significantly higher in patients with any AF (odds ratio [OR]: 2.7, 2.2, 1.9, respectively; P < .001) and in patients with new-onset AF (OR: 5.2, 3.9, 3.1, respectively; P < .001. In conclusion, AF in patients with ACS was associated with significantly higher short- and long-term mortality.
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Affiliation(s)
- Ahmad Hersi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alawi A. Alsheikh-Ali
- Department of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Hussam F. Alfaleh
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shukri Alsaif
- Cardiology Department, Saud Al-Babtain Cardiac Center, Dammam, Saudi Arabia
| | - Wael Al- Mahmeed
- Department of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Nidal Asaad
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Amin Haitham
- Cardiology Department, Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain
| | - Ahmed Al-Motarreb
- Department of Medicine, Faculty of Medicine, Sana’a University, Sana’a Yemen
| | - Jassim Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdullah Shehab
- Department of Medicine, The Faculty of Medicine & Health Sciences (FMHS), UAE University, Abu Dhabi, United Arab Emirates
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