Riccardo Proietti1, Lucio Gonzini2, Giovanni Pizzimenti3, Antonietta Ledda4, Pietro Sanna5, Ahmed AlTurki6,7, Vincenzo Russo8, Mauro Lencioni9. 1. Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy. 2. ANMCO Research Center, Florence, Italy. 3. Cardiology Department, Giuseppe Fogliani Hospital, Milazzo, Italy. 4. Cardiology Department, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy. 5. Cardiology Department, San Francesco Hospital, Nuoro, Italy. 6. Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada. 7. Department of Medicine, McGill University, Montreal, Quebec, Canada. 8. Chair of Cardiology, University of Campania "Luigi Vanvitelli", Ospedale Monaldi, Naples, Italy. 9. Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK.
Abstract
OBJECTIVE: An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA-AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF. METHODS AND RESULTS: The ATA-AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post-hoc analysis included 1097 AF patients with eGFR data available and 1-year clinical follow-up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow-up. Patients were also divided in two groups according to the eGFR (<60 and ≥60 mL/min/1.73 m2 ). The Kaplan-Meyer curve for the mentioned endpoint showed a higher endpoint incidence in the group of patient with eGFR below 60 mL/min/1.73 m2 (P < 0.001). Using multivariate analysis (Cox regression), a trend toward a higher rate of occurrence of the primary endpoint was observed for eGFR below 60 mL/min/1.73 m2 without reaching the conventional level of statistical significance (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.99-1.99; P = 0.0572). When eGFR was included in the analysis as continuous variable a significant correlation was observed with the combined endpoint at the Cox regression (HR 0.99, 95% CI 0.98-0.99, P = 0.04). CONCLUSION: The result of this post-hoc analysis indicates that an impaired eGFR is independently associated with worse prognosis among patients with AF.
OBJECTIVE: An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA-AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF. METHODS AND RESULTS: The ATA-AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post-hoc analysis included 1097 AFpatients with eGFR data available and 1-year clinical follow-up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow-up. Patients were also divided in two groups according to the eGFR (<60 and ≥60 mL/min/1.73 m2 ). The Kaplan-Meyer curve for the mentioned endpoint showed a higher endpoint incidence in the group of patient with eGFR below 60 mL/min/1.73 m2 (P < 0.001). Using multivariate analysis (Cox regression), a trend toward a higher rate of occurrence of the primary endpoint was observed for eGFR below 60 mL/min/1.73 m2 without reaching the conventional level of statistical significance (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.99-1.99; P = 0.0572). When eGFR was included in the analysis as continuous variable a significant correlation was observed with the combined endpoint at the Cox regression (HR 0.99, 95% CI 0.98-0.99, P = 0.04). CONCLUSION: The result of this post-hoc analysis indicates that an impaired eGFR is independently associated with worse prognosis among patients with AF.
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