Daniele Pastori1, Pasquale Pignatelli1, Francesco Angelico2, Alessio Farcomeni2, Maria Del Ben1, Tommasa Vicario1, Tommaso Bucci1, Valeria Raparelli1, Roberto Cangemi1, Gaetano Tanzilli3, Gregory Y H Lip4, Francesco Violi5. 1. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy. 2. Department of Science of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. 3. Department of the Heart and Great Vessels Attilio Reale, Sapienza University of Rome, Rome, Italy. 4. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England. 5. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy. Electronic address: francesco.violi@uniroma1.it.
Abstract
BACKGROUND: Recent findings suggest that patients with atrial fibrillation (AF), in addition being at thromboembolic risk, are at risk of myocardial infarction (MI). Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants. METHODS: We prospectively followed up 1,019 patients with AF for a median of 33.7 months (3,223 person-years). All patients were treated with oral vitamin K antagonists. Primary outcome was a composite end point of cardiovascular events (CVEs) including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death. RESULTS: The mean age of the patients was 73.2 years, and 43.8% were women. At follow-up, 111 CVEs (3.43%/y) had occurred: 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths. In addition, 31 stroke/transient ischemic attacks (0.96%/y) were recorded. Patients experiencing CVEs were older (P < .001) and had a higher prevalence of metabolic syndrome (MetS) (P = .005), heart failure (P = .001), and prior cardiac (P < .001) and cerebrovascular events (P < .001). On a Cox proportional hazard analysis, age (hazard ratio [HR], 1.083; 95% CI, 1.053-1.113; P < .001), smoking (HR, 2.158; 95% CI, 1.193-3.901; P = .011), history of cerebrovascular (HR, 1.704; 95% CI, 1.119-2.597; P = .013) and cardiac (HR, 1.658; 95% CI, 1.105-2.489; P = .015) events, MetS (HR, 1.663; 95% CI, 1.107-2.499; P = .014), heart failure (HR, 1.584; 95% CI, 1.021-2.456; P = .040), and male sex (HR, 1.499; 95% CI, 1.010-2.223; P = .044) predicted CVEs. CONCLUSIONS: Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment. MetS is a common clinical feature in patients with AF, which increases the risk of CVEs. A holistic approach is needed to reduce the cardiovascular risk in patients with AF. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01882114; URL: www.clinicaltrials.gov.
BACKGROUND: Recent findings suggest that patients with atrial fibrillation (AF), in addition being at thromboembolic risk, are at risk of myocardial infarction (MI). Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants. METHODS: We prospectively followed up 1,019 patients with AF for a median of 33.7 months (3,223 person-years). All patients were treated with oral vitamin K antagonists. Primary outcome was a composite end point of cardiovascular events (CVEs) including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death. RESULTS: The mean age of the patients was 73.2 years, and 43.8% were women. At follow-up, 111 CVEs (3.43%/y) had occurred: 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths. In addition, 31 stroke/transient ischemic attacks (0.96%/y) were recorded. Patients experiencing CVEs were older (P < .001) and had a higher prevalence of metabolic syndrome (MetS) (P = .005), heart failure (P = .001), and prior cardiac (P < .001) and cerebrovascular events (P < .001). On a Cox proportional hazard analysis, age (hazard ratio [HR], 1.083; 95% CI, 1.053-1.113; P < .001), smoking (HR, 2.158; 95% CI, 1.193-3.901; P = .011), history of cerebrovascular (HR, 1.704; 95% CI, 1.119-2.597; P = .013) and cardiac (HR, 1.658; 95% CI, 1.105-2.489; P = .015) events, MetS (HR, 1.663; 95% CI, 1.107-2.499; P = .014), heart failure (HR, 1.584; 95% CI, 1.021-2.456; P = .040), and male sex (HR, 1.499; 95% CI, 1.010-2.223; P = .044) predicted CVEs. CONCLUSIONS:Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment. MetS is a common clinical feature in patients with AF, which increases the risk of CVEs. A holistic approach is needed to reduce the cardiovascular risk in patients with AF. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01882114; URL: www.clinicaltrials.gov.
Authors: Min Yang; Wenrui Bao; Zhihan Xu; Le Qin; Ning Zhang; Fuhua Yan; Wenjie Yang Journal: Int J Cardiovasc Imaging Date: 2022-02-15 Impact factor: 2.357
Authors: Valeria Raparelli; Daniele Pastori; Serena Francesca Pignataro; Anna Rita Vestri; Pasquale Pignatelli; Roberto Cangemi; Marco Proietti; Giovanni Davì; William Robert Hiatt; Gregory Yoke Hong Lip; Gino Roberto Corazza; Francesco Perticone; Francesco Violi; Stefania Basili Journal: Intern Emerg Med Date: 2018-03-26 Impact factor: 3.397
Authors: Francesco Violi; Daniele Pastori; Francesco Perticone; William R Hiatt; Angela Sciacqua; Stefania Basili; Marco Proietti; Gino R Corazza; Gregory Y H Lip; Pasquale Pignatelli Journal: BMJ Open Date: 2015-05-21 Impact factor: 2.692