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Balomenakis C, Papazoglou A, Vlachopoulou D, Kartas A, Moysidis D, Vouloagkas I, Tsagkaris C, Samaras A, Krystalli C, Karagiannidis E, Giannakoulas G. Risk of arterial thromboembolism in patients with concomitant atrial fibrillation and cancer: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Atrial fibrillation (AF) and cancer often co-exist and have been independently associated with increased risk of arterial thromboembolism (TE), all cause death and bleeding; however, no cumulative data exist regarding the clinical course of AF patients with comorbid cancer.
Purpose
The aim of this systematic review and meta-analysis is to synthesize the available data regarding the incidence of major adverse cardiovascular events in AF patients in association with concurrent cancer.
Methods
The composite outcome of any TE (ischemic stroke, transient ischemic attack, or arterial thrombosis) was defined as the primary study outcome, while all-cause mortality and major or clinically relevant non-major bleeding occurrence as the secondary ones. Literature search was conducted in PubMed (MEDLINE), WebOfScience, Scopus, CENTRAL, OpenGrey, and EThOS databases. A random-effects model meta-analysis was performed. Subgroup analyses were conducted assessing the effect of active cancer history and various cancer subtypes on the outcomes of interest. Meta-regression analyses were also performed to examine the relative impact of CHA2DS2VASC and HASBLED prognostic scores on the risk of TE and bleeding, respectively.
Results
Overall 17 studies were included in our analysis, encompassing a total of 3,151,861 AF patients. Comorbid cancer was non-significantly associated with lower odds of TE than AF alone (pooled odds ratio (pOR) = 0.85, 95% confidence interval (CI): 0.69–1.03, I2=87%). The likelihood for all-cause death and bleeding occurrence was significantly higher in AF patients with cancer (pOR = 2.27, 95% CI: 1.69–3.06, I2=99%); pOR = 1.58, 95% CI: 1.26–1.97, I2=97% respectively) compared to those without cancer. Subgroup analysis on active cancer status did not yield any substantial difference, marginally improving the heterogeneity of our analysis. The highest all-cause mortality likelihood was observed in Liver-Pancreas-Gallbladder category (pOR = 10.58, 95% CI: 4.69–23.88, I2=98%) while the highest bleeding likelihood was encountered in Genitourinary cancer (pOR = 1.90, 95% CI: 1.42–2.55, I2=71.9%). The performed meta-regression analyses did not yield any significant results.
Conclusions
Our meta-analysis of 17 eligible studies demonstrated that cancer does not seem to be associated with increased risk of TE, while with increased all-cause death and bleeding occurrence in AF patients. This correlation might be explained by higher cancer-driven mortality rates (competing risk), many cases of TE being left undiagnosed within the scope of palliative cancer care, misdiagnosed episodes of TE due to the presence of brain metastases, optimal cardio-oncology monitoring, and more frequent usage of prophylactic anticoagulation treatment for cancer-associated venous thromboembolism. Nonetheless, further competing-risk survival analyses are warranted before reaching definite conclusions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Balomenakis
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - A Papazoglou
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - D Vlachopoulou
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - A Kartas
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - D Moysidis
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - I Vouloagkas
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - C Tsagkaris
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - A Samaras
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - C Krystalli
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - E Karagiannidis
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - G Giannakoulas
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
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2
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Samaras A, Vrana E, Kartas A, Rampidis G, Doundoulakis I, Fotos G, Efthimiadis G, Karvounis H, Tzikas A, Giannakoulas G. Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) and valvular heart disease (VHD) are frequently encountered in clinical practice, and often coexist, especially in the elderly population. Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of their coexistence.
Purpose
To evaluate the prognostic effect of significant valvular heart disease (sVHD) among patients with non-valvular AF.
Methods
This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction.
Results
In total, 983 patients with non-valvular AF (median age 76 years) were analyzed over a median follow-up period of 32 months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 1.6%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p=0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR1.70, 95% CI 1.09–2.66; p=0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p=0.02). The prognostic effect of sVHD was particularly evident in patients aged <80 years and in those without history of heart failure (p for interaction <0.05, in both subgroups) [Figure 1]. After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization [Figure 2]. AS was the only independent predictor of valve intervention during follow-up (aHR 10.78, 95% CI 4.80–24.22; p<0.001). Mixed aortic valve disease (AS+AR) had superior prognostic power across patterns of combined VHD.
Conclusions
Among patients with non-valvular AF, sVHD was highly prevalent, and beared high prognostic value across a wide spectrum of clinical outcomes. AS, MR, TR and mixed aortic valve disease were associated with worse prognosis.
Funding Acknowledgement
Type of funding sources: None. Subgroup analyses by VHD statusPrognostic impact of valve lesions
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Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Vrana
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Rampidis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - I Doundoulakis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Efthimiadis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
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3
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Papazoglou A, Kartas A, Samaras A, Vouloagkas I, Vrana E, Moysidis D, Akrivos E, Kotzampasis G, Papanastasiou A, Baroutidou A, Botis M, Tsagkaris C, Karagiannidis E, Tzikas A, Giannakoulas G. Prognostic significance of diabetes mellitus in patients with atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite the plethora of studies on atrial fibrillation (AF) and diabetes mellitus (DM), there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF.
Purpose
The purpose of this study was to investigate the association of DM and levels of glycated hemoglobin (HbA1c) with outcomes in patients with AF.
Methods
This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality, stroke and the composite outcome of CV death or hospitalization. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM.
Results
In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.44, 95% confidence intervals [CI]: 1.12-1.85), CV mortality (aHR = 1.44, 95% CI: 1.08-1.93), stroke (aHR = 2.62, 95% CI: 1.24-5.53) and the composite outcome of hospitalization or CV death (aHR = 1.28, 95% CI: 1.06-1.54). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values <6.2% predicting significantly decreased all-cause and CV mortality.
Conclusions
The presence of DM on top of AF was associated with a 1.5-fold increased risk for all-cause or CV mortality and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates. Follow-up outcomes by presence of DMOutcomeDMNon-DMAdjusted HR(95% CI)p-valueAll-cause death171/373 (45.8%)243/736 (33%)1.44 (1.12-1.85)<0.001CV-death130/373 (34.9%)173/736 (23.5%)1.44 (1.08-1.93)<0.001Major bleeding18/340 (5.3%)29/644 (4.5%)1.53 (0.71-3.28)0.291Stroke24/340 (7.1%)28/645 (4.3%)2.62 (1.24-5.53)0.013AF-related hospitalization59/340 (17.4%)115/645 (17.8%)1.20 (0.78-1.85)0.281HF-related hospitalization35/333 (10.5%)46/640 (7.2%)1.34 (0.83-2.19)0.235Hospitalization or CV-death243/373 (65.1%)399/736(54.2%)1.28 (1.06-1.54)<0.001*Adjusted for: age, gender, smoking, BMI, history of hypertension, eGFR (CKD-EPI) and use of statin, ACEI-ARB, OAC and rate control medication after discharge.DM, diabetes mellitus; HR, hazard ratio; AF, atrial fibrillation; CV, cardiovascular; HF, heart failure.Abstract Figure. Visual overview of the study
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Affiliation(s)
- A Papazoglou
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Kartas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Samaras
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - I Vouloagkas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - E Vrana
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - D Moysidis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - E Akrivos
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Kotzampasis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Papanastasiou
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Baroutidou
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - M Botis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | - E Karagiannidis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Tzikas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - G Giannakoulas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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4
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Tsagkaris C, Kartas A, Samaras A, Papazoglou A, Moysidis D, Vrana E, Vouloagkas I, Papanastasiou A, Kotzampasis G, Baroutidou A, Karagiannidis E, Louka AM, Matiashova L, Tzikas A, Giannakoulas G. Polypharmacy and major adverse events in atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Polypharmacy has been defined as the daily use of more than 4 drugs, by an individual, regardless of the condition(s) they have been prescribed for and their efficacy. The burden of polypharmacy pertains to adverse drug reactions, disability, frequent and longtime hospitalization and long-term mortality. The prevalence of polypharmacy exceeds 10% in most adult age groups and particularly in the elderly. At the same time, atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, afflicting more than 8% of the elderly and those with multiple comorbidities.
Purpose
The purpose of this study was to examine the association between the presence of polypharmacy and outcomes among AF patients.
Methods
This is a retrospective analysis among 1140 patients enrolled in the MISOAC-AF trial. All cause- and cardiovascular- mortality have been defined as primary endpoints. Independent clinical predictors of polypharmacy and of major adverse outcomes were identified via bootstrapped multivariate logistic and Cox regression analysis, respectively.
Results
The mean number of prescribed medications at patients’ discharge was 3.9 ± 1.6 and polypharmacy (use of more than 4 medications daily) was found in 36.9% of the patients. Smoking (p = 0.036), dyslipidemia (p < 0.001), coronary artery disease (p < 0.001), heart failure (HF; p = 0.003) and chronic kidney disease (p < 0.001) were independent predictors of polypharmacy among AF paients. Kaplan–Meier survival analysis showed that AF patients with polypharmacy have significantly greater risk of CV death (p = 0.040), while Cox regression analysis indicated polypharmacy as an independent predictor for all-cause and CV- mortality [adjusted hazard ratios: 1.31(1.03 - 1.67) and 1.39(1.05 - 1.84), respectively] and for the composite outcome of AF- or HF- related hospitalization or CV death [adjusted hazard ratio: 1.31 (1.05 - 1.63)].
Conclusion
This study highlights the implications of polypharmacy in the context of AF, a prevalent, chronic, life-threatening condition. Investigating polypharmacy is quite relevant in the era of pharmacovigilance, contributing to rational pharmacotherapy with regard to cardiovascular conditions and beyond. Abstract Figure. Mortality rates by polypharmacy presence
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Affiliation(s)
| | - A Kartas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Samaras
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Papazoglou
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - D Moysidis
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - E Vrana
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - I Vouloagkas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Papanastasiou
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - G Kotzampasis
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Baroutidou
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - E Karagiannidis
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A-M Louka
- Novel Global Community Educational Foundation, Hebersham, Australia
| | - L Matiashova
- Government Institution L.T. Malaya Therapy National Institute of the National Academy of Medical Sci, Kharkiv, Ukraine
| | - A Tzikas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - G Giannakoulas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
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5
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Mpotis M, Kartas A, Samaras A, Akrivos E, Vrana E, Liampas E, Papazoglou A, Moysidis D, Papanastasiou A, Baroutidou A, Karvounis H, Tzikas A, Giannakoulas G. Digoxin and association with mortality in patients discharged from hospital with atrial fibrillation, with or without heart failure. Europace 2021. [DOI: 10.1093/europace/euab116.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
MISOAC- AF study group
BACKGROUND
Digoxin is widely used in atrial fibrillation (AF) and heart failure (AF). However, established evidence is conflicting regarding its association with clinical outcomes.
AIM
To investigate the relation between digoxin and adverse outcomes in patients with AF, with or without HF, in a contemporary AF cohort.
METHODS
We performed a retrospective analysis of data from 698 patients, originating from the MISOAC- AF (Motivational Interviewing to Support Oral AntiCoagulation Adherence in patients with non-valvular Atrial Fibrillation) trial, and followed over a median of 2.5 years. HF was denoted at baseline. The primary outcome was all-cause mortality and the secondary outcome was all-cause hospitalization, in a time-to-event analysis. Propensity scores were used to derive matched populations, balanced on key baseline covariates. To limit potential confounding, we also implemented inverse probability of treatment weighting (IPTW) analysis.
RESULTS
Among patients with HF, 10.5% (n = 39) were administered digoxin at baseline, whereas 89.5% (n = 331) were not. Digoxin administration was not associated with an increased risk of death (hazard ratio (HR) in the digoxin group, 1.21; 95% Confidence Interval (CI), 0.69 to 2.13, p = 0.5) or hospitalization of any cause (HR 1.15; 95% CI, 0.67 to 1.96; p = 0.6). Among patients without HF, 3.5% (n = 11) were administered digoxin, with neutral effects on all-cause mortality (HR: 3.25; 95% CI, 0.98 to 10.70), p = 0.06) and all-cause hospitalization (HR, 1.15; 95% CI, 0.67 to 1.96, p = 0.60). Consistent qualitatively results were observed using IPTW.
CONCLUSIONS
Among patients with AF, digoxin administration was not associated with an increased risk of death and hospitalization of any cause, irrespective of HF status. Abstract Figure.
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Affiliation(s)
- M Mpotis
- 251 Hellenic Air Force General Hospital, Athens, Greece
| | - A Kartas
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Samaras
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - E Akrivos
- Aristotle University of Thessaloniki, Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Thessaloniki, Greece
| | - E Vrana
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - E Liampas
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Papazoglou
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - D Moysidis
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Papanastasiou
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Baroutidou
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - H Karvounis
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Tzikas
- Interbalkan Medical Center, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
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Zafeiropoulos S, Farmakis IT, Kartas A, Psarakis G, Kourti O, Tsolakidis C, Konstantas O, Touriki A, Baroutidou A, Vrana E, Graidis S, Psathas T, Miyara SJ, Karvounis H, Giannakoulas G. Predictors of all-cause mortality within and beyond 1 year after an acute coronary syndrome. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients discharged after an acute coronary syndrome (ACS) have substantial mortality risk, especially during the first year.
Purpose
To determine differences between first year and long-term all-cause mortality of patients after an ACS and identify its risk predictors.
Methods
This is a post-hoc analysis of the baseline data from 360 patients after ACS with a median follow up 3.2 years (IQR: 2.5-3.8) that enrolled in a prospective randomized controlled trial. Mortality rates with 95% confidence intervals (CIs) were estimated by Kaplan–Meier method. Multivariate Cox proportional hazards regression analyses of clinical parameters and cardiac biomarkers were performed to identify predictors for all-cause mortality within first year and thereafter.
Results
In our cohort, all-cause mortality incidence per 100 person-years at risk within and after first year was 4.9 and 2.1, respectively (RR = 2.3, p < 0.001). Notably, 83% of the deaths during the first year were attributed to any cardiovascular cause, dropped to 50% after the first year. Baseline NT-proBNP value and prior myocardial infarction were the main independent predictors of all-cause mortality for both first year and beyond time periods (Table 1). Οn the contrary, severe chronic kidney disease lost predictive power after 1 year.
Conclusion
We observed higher all-cause mortality rate during the first year, mainly driven by cardiovascular death. History of myocardial infarction and baseline NT-proBNP levels outperformed any other clinical variable or biomarker for long-term all-cause mortality in post-ACS patients.
Predictors of long-term all-cause death Variables Univariate analysis Multivariate analysis HR (95% CI) P-value HR (95% CI) P-value Age per 1-year increase 1.06 (1.03 - 1.10) <0.001 1.02 (0.99 - 1.06) 0.11 Female 1.07 (0.79 - 3.71) 0.17 HTN 2.52 (1.14 - 5.63) 0.02 Diabetes 2.06 (1.03 - 4.15) 0.04 CKD IV or V 9.01 (3.89 - 20.86) <0.001 0.88 (0.26 - 2.95) 0.83 History of MI 0.55 (0.26 - 1.17) 0.001 3.28 (1.05 - 7.17) 0.002 HFrEF 1.25 (0.51 - 3.04) 0.62 Family history of CAD 0.55 (0.26 - 1.17) 0.12 NT-proBNP* 1.92 (1.46 - 2.51) <0.001 1.70 (1.22 - 2.36) 0.001 hs-cTnT* 1.15 (0.91 - 1.44) 0.27 LDL-C 0.99 (0.98 - 1.00) 0.22 *Natural logarithms
Abstract Figure. Kaplan-Meier for all-cause mortality
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Affiliation(s)
- S Zafeiropoulos
- Feinstein Institutes for Medical Research, Manhasset, United States of America
| | - IT Farmakis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - G Psarakis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - O Kourti
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - C Tsolakidis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - O Konstantas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Touriki
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Baroutidou
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - E Vrana
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - S Graidis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - T Psathas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - SJ Miyara
- Feinstein Institutes for Medical Research, Manhasset, United States of America
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
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7
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Kamperidis V, Vlachou M, Pappa Z, Pantelidou D, Karamitsos T, Papadopoulou D, Kartas A, Vlachaki E, Giannakoulas G, Karvounis H. Prediction of long-term survival in haemoglobinopathies: insights from cardiac imaging and ferritin. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims.The data on echocardiography, cardiac magnetic resonance (CMR) and ferritin predicting long-term survival in haemoglobinopathies are scarce. The current study evaluated the association of these parameters with the 10-years survival in haemoglobinopathies.
Methods.This prospective study included stable consecutive haemoglobinopathy patients .Demographics, ferritin, echocardiography and CMR parameters were prospectively collected.
Results. In total, 83 patients (mean age 38.4 ± 12.0 years, 46% male) with haemoglobinopathies were included and dichotomized based on their survival status after a follow-up of 9.8 ± 1.4 years. Patients who died were older (45.3 ± 11.6 vs 37.1 ± 11.7 years, p = 0.025), had higher ferritin levels (2498 vs 754 ng/ml, p = 0.001), higher right ventricular systolic pressure (RVSP) (41 ± 10 vs 31 ± 11mmHg, p = 0.001), more frequently elevated left ventricular (LV) end-diastolic pressure (70 vs 35%, p = 0.039) and lower CMR T2* values (23 ± 12 vs 35 ± 12ms, p = 0.007). Older age (HR: 1.053, p = 0.018), ferritin >2000ng/ml (HR: 3.517, p = 0.03), and >950ng/ml (HR: 11,135, p = 0.02), elevated LV end-diastolic pressure (HR: 3.977, p = 0.046), RVSP >34mmHg(HR: 10,134, p = 0.003), CMR T2* <20msec (HR: 4.900, p = 0.018) and <36msec (HR: 9.376, p = 0.035) were associated with increased all-cause mortality. A baseline model including age was created andit became more predictive of worse survival by adding RVSP >34mmHg than elevated LV end-diastolic pressure (C index 0.777 vs. 0.757 respectively) or ferritin >950ng/ml than >2000ng/ml (C index 0.805 vs. 0.770 respectively) or CMR T2*<36msec than <20msec (C index 0.825 vs. 0.810 respectively).
Conclusions. In haemoglobinopathy patients, RVSP >34mmHg, ferritin >2000ng/ml and CMR T2* <20ms were associated with worse long term survival.In the current era of advanced chelation therapy, aiming for ferritin <950ng/ml and CMR T2* >36ms appears to improve their prognosis.
Abstract Figure.
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Affiliation(s)
- V Kamperidis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - M Vlachou
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Z Pappa
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - D Pantelidou
- Ahepa General Hospital of Aristotle University, Thalassaemia Unit, Thessaloniki, Greece
| | - T Karamitsos
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - D Papadopoulou
- Ahepa General Hospital of Aristotle University, Thalassaemia Unit, Thessaloniki, Greece
| | - A Kartas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - E Vlachaki
- Hippokration General Hospital of Thessloniki, Thalassaemia Unit, Thessaloniki, Greece
| | - G Giannakoulas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - H Karvounis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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8
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Sofidis G, Stalikas N, Papathemeli D, Karagiannidis E, Kartas A, Papazoglou A, Otountzidis N, Natsis K, Lazaridou E, Patsatsi A, Sianos G. Correlation of psoriasis severity with angiographic coronary artery disease complexity: a Cross-Sectional study. J Eur Acad Dermatol Venereol 2021; 35:e372-e373. [PMID: 33545744 DOI: 10.1111/jdv.17143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Affiliation(s)
- G Sofidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Stalikas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Papathemeli
- 2nd Department of Dermatology and Venereology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Karagiannidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Kartas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Papazoglou
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Otountzidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health and Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Lazaridou
- 2nd Department of Dermatology and Venereology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Patsatsi
- 2nd Department of Dermatology and Venereology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Sianos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Kartas A, Samaras A, Vasdeki D, Dividis G, Fotos G, Paschou E, Forozidou E, Tsoukra P, Kotsi E, Goulas I, Karagiannidis E, Karvounis H, Tzikas A, Giannakoulas G. Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear.
OBJECTIVES
To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF.
Methods
We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression.
Results
HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P<0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p<0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF.
Conclusions
HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Kartas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - A Samaras
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - I Goulas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | | | - H Karvounis
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
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10
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Zafeiropoulos S, Farmakis I, Kartas A, Arvanitaki A, Pagiantza A, Boulmpou A, Tampaki A, Kosmidis D, Nevras V, Markidis E, Papadimitriou I, Arvanitakis K, Ziakas A, Karvounis H, Giannakoulas G. Risk for recurrent cardiovascular events and expected risk reduction with optimal treatment one year after an acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
According to the latest ESC Guidelines for chronic coronary syndromes (CCS), patients who suffered an acute coronary syndrome (ACS) pass to a chronic stable phase after one year. In these patients the estimated 10-year risk for recurrent cardiovascular (CV) events varies considerably. We estimated this risk and the expected risk reduction after optimal control.
Methods
We applied the SMART risk score in 211 patients one year after an ACS to estimate the 10-year risk for recurrent CV events (subsequent non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death). We assessed the distribution of the estimated risk and the potential risk reduction that might be achieved with an optimal guideline-directed management of modifiable risk factors (systolic blood pressure, low-density lipoprotein cholesterol, smoking and body mass index).
Results
In our cohort, the median SMART score was 16% [interquartile range (IQR), 9.5–26]. If all modifiable risk factors met guideline-recommended targets, median SMART risk score would be 9.4% (IQR, 5.9–17.1), with 52% of the patients at a 10-year risk <10%, while 10% and 11% at 20–30% and >30% risk respectively. The total median reducible risk was 4.7% (IQR, 1.7–8.8).
Conclusions
The SMART score had a wide distribution among patients with CCS. Noteworthy, one out of five patients will remain at a >20% 10-year risk, even with optimal risk factors management, clearly underlining that residual risk is an unmet clinical issue, which demands individualized patient care.
Baseline and total residual risk score
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Zafeiropoulos
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - I.T Farmakis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Arvanitaki
- University Hospital of Munster, Department of Cardiology III - Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - A Pagiantza
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - A Tampaki
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - D Kosmidis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - V Nevras
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - E Markidis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - I Papadimitriou
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - K Arvanitakis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - A Ziakas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology Department, Thessaloniki, Greece
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11
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Tzikas A, Samaras A, Kartas A, Vasdeki D, Fotos G, Dividis G, Paschou E, Forozidou E, Tsoukra P, Kotsi E, Goulas I, Karvounis H, Giannakoulas G. Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF).
Purpose
We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF.
Methods
Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range<70%) and clinical events.
Results
A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC>80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p<0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p<0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table].
Conclusions
In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes.
Primary and secondary outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Tzikas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Samaras
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - I Goulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
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12
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Samaras A, Kartas A, Vasdeki D, Dividis G, Forozidou E, Fotos G, Kotsi E, Paschou E, Tsoukra P, Goulas I, Karvounis H, Giannakoulas G, Tzikas A. Rationale and design of a randomized study comparing Motivational Interviewing to Support Oral Anticoagulation adherence versus usual care in patients with nonvalvular atrial fibrillation: The MISOAC-AF trial. Hellenic J Cardiol 2020; 61:453-454. [PMID: 32259588 DOI: 10.1016/j.hjc.2020.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- A Samaras
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - A Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - D Vasdeki
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - G Dividis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - E Forozidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - G Fotos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - E Kotsi
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - E Paschou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - P Tsoukra
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - I Goulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - H Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - G Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - A Tzikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece; Interbalkan European Medical Center, Asklipiou 10, Pylaia, Thessaloniki, Greece.
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13
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Samaras A, Kartas A, Fotos G, Vasdeki D, Dividis G, Paschou E, Tsoukra P, Forozidou E, Kotsi E, Goulas I, Karvounis H, Giannakoulas G, Tzikas A. P1869A novel risk score to predict mortality in patients with atrial fibrillation: the BLACCK (AF) death risk score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Prior risk stratification schemes for atrial fibrillation (AF) have extensively focused on stroke as the principal outcome. However, an accurate estimation of the risk of death in patients with AF has received disproportional attention.
Purpose
The aim of this study was to develop and validate a risk score for predicting mortality in patients with AF who underwent a hospitalization for cardiac reasons.
Methods
The new risk score was developed and internally validated in 887 patients with AF, who were followed up for a median of 2 years. The outcome measure was all-cause mortality. Biomarker samples, echocardiographic data and renal function values were obtained at the date closest to hospital discharge. A Cox-model that determined the variables that significantly contributed to the prediction of all-cause mortality, was adapted to a risk points system through weighting of the model coefficients. The model was internally validated by bootstrapping, assessing both discrimination and calibration.
Results
311 all-cause deaths were reported during 1755 person-years of follow-up (incidence rate 17.7 events per 100 person-years). The most important predictors of death were N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin-T (hs-TnT), left atrial area indexed to body surface area (LAAi), prior cardiac arrest, kidney impairment, congestive heart failure and age, and were included in the BLACCK (AF) death risk score. The score was well-calibrated (observed probabilities adjusted to predicted probabilities) and showed good discriminative ability [c-index 0.87 (95% CI 0.85–0.90)]. The internal validation of the score reported minimal over-fitting (optimism-corrected c-index of 0.85). The 1, 2 and 3-year risk of death derived by the score's total points may be calculated immediately through the nomogram (Figure 1).
BLACCK (AF) risk score nomogram
Conclusions
We developed a simple, well-calibrated and internally validated novel risk score for predicting 1, 2 and 3-year risk of death in patients with AF after a hospitalization for cardiac reasons. The BLACCK (AF) death risk score included both cardiac biomarkers and clinical information, performed well and may assist physicians in decision-making when treating patients with AF.
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Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - I Goulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
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14
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Paschou E, Samaras A, Goulas I, Dividis G, Fotos G, Vasdeki D, Forozidou E, Tsoukra P, Kotsi E, Kartas A, Karvounis H, Tzikas A, Giannakoulas G. P6232ABC-death risk score predicts mortality better than CHA2DS2-VASc score in a contemporary population of hospitalised patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E Paschou
- AHEPA General Hospital, Thessaloniki, Greece
| | - A Samaras
- AHEPA General Hospital, Thessaloniki, Greece
| | - I Goulas
- AHEPA General Hospital, Thessaloniki, Greece
| | - G Dividis
- AHEPA General Hospital, Thessaloniki, Greece
| | - G Fotos
- AHEPA General Hospital, Thessaloniki, Greece
| | - D Vasdeki
- AHEPA General Hospital, Thessaloniki, Greece
| | - E Forozidou
- AHEPA General Hospital, Thessaloniki, Greece
| | - P Tsoukra
- AHEPA General Hospital, Thessaloniki, Greece
| | - E Kotsi
- AHEPA General Hospital, Thessaloniki, Greece
| | - A Kartas
- AHEPA General Hospital, Thessaloniki, Greece
| | - H Karvounis
- AHEPA General Hospital, Thessaloniki, Greece
| | - A Tzikas
- AHEPA General Hospital, Thessaloniki, Greece
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15
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Samaras A, Fotos G, Dividis G, Paschou E, Thomaidou E, Goulas J, Vasdeki D, Forozidou E, Tsoukra P, Kotsi E, Kartas A, Giannakoulas G, Karvounis H, Tzikas A. P386Factors associated with the prescription practices of non-vitamin K antagonists in non valvular atrial fibrillation in daily clinical practice. Europace 2018. [DOI: 10.1093/europace/euy015.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Thomaidou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - J Goulas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
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