Yan-Guang Li1, Kazuo Miyazawa2, Daniele Pastori3, Orsolya Szekely2, Farhan Shahid2, Gregory Y H Lip4. 1. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China. 2. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom. 3. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy. 4. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: Gregory.Lip@liverpool.ac.uk.
Abstract
BACKGROUND: Patients with cardiac implantable electronic device (CIED) developing atrial high-rate episodes (AHRE) have a significant risk of thromboembolic events (TEs), but risk factors have been scarcely investigated. OBJECTIVES: To analyze risk factors for TEs in a contemporary cohort of patients with CIED. METHODS: Consecutive non-AF patients without anticoagulation at baseline were followed up after the CIED implantation. The role of newly-developed AHRE and other risk factors for TEs were analyzed using a time-dependent Cox regression model and Kaplan-Meier analysis with log-rank tests. RESULTS: A total of 594 CIED patients were followed up for a mean of 4.2 years: 175 developed AHRE (29.5%; incident rate [IR] 8.80% per patient-year). Of those, 33 experienced TEs (5.5%; IR 1.38% per patient-year). Incidence of TEs was low in patients with a CHA2DS2-VASc score < 2 (male)/<3 (female) (AHRE vs. no-AHRE, 0.60% vs. 0.00% per patient-year, p = 0.469) and high in those with score ≥ 2 (male)/≥3 (female) (AHRE vs. no-AHRE, 2.12% vs. 1.36% per patient-year, p = 0.209), regardless of the AHRE presence. AHRE was not significantly associated with TEs (hazard ratio [HR], 1.46 [0.64-3.33]). There was no temporal relationship between AHRE and TEs. Baseline CHA2DS2-VASc score was independently associated with TEs (HR, 1.41 [1.13-1.75]) on multivariate analysis, but not AHRE. CONCLUSIONS: Thromboembolic risk in patients with CIED is mainly driven by comorbidity burden, i.e., CHA2DS2-VASc score, rather than AHRE per se. Decision-making on stroke prevention needs to focus on comorbidity burden and not merely on the presence or absence of AHRE in CIED patients.
BACKGROUND:Patients with cardiac implantable electronic device (CIED) developing atrial high-rate episodes (AHRE) have a significant risk of thromboembolic events (TEs), but risk factors have been scarcely investigated. OBJECTIVES: To analyze risk factors for TEs in a contemporary cohort of patients with CIED. METHODS: Consecutive non-AFpatients without anticoagulation at baseline were followed up after the CIED implantation. The role of newly-developed AHRE and other risk factors for TEs were analyzed using a time-dependent Cox regression model and Kaplan-Meier analysis with log-rank tests. RESULTS: A total of 594 CIEDpatients were followed up for a mean of 4.2 years: 175 developed AHRE (29.5%; incident rate [IR] 8.80% per patient-year). Of those, 33 experienced TEs (5.5%; IR 1.38% per patient-year). Incidence of TEs was low in patients with a CHA2DS2-VASc score < 2 (male)/<3 (female) (AHRE vs. no-AHRE, 0.60% vs. 0.00% per patient-year, p = 0.469) and high in those with score ≥ 2 (male)/≥3 (female) (AHRE vs. no-AHRE, 2.12% vs. 1.36% per patient-year, p = 0.209), regardless of the AHRE presence. AHRE was not significantly associated with TEs (hazard ratio [HR], 1.46 [0.64-3.33]). There was no temporal relationship between AHRE and TEs. Baseline CHA2DS2-VASc score was independently associated with TEs (HR, 1.41 [1.13-1.75]) on multivariate analysis, but not AHRE. CONCLUSIONS:Thromboembolic risk in patients with CIED is mainly driven by comorbidity burden, i.e., CHA2DS2-VASc score, rather than AHRE per se. Decision-making on stroke prevention needs to focus on comorbidity burden and not merely on the presence or absence of AHRE in CIEDpatients.
Authors: Gelu Simu; Radu Rosu; Gabriel Cismaru; Mihai Puiu; Gabriel Gusetu; Ioan Minciuna; Sabina Istratoaie; Raluca Tomoaia; Dumitru Zdrenghea; Dana Pop Journal: Cardiovasc J Afr Date: 2021-01-15 Impact factor: 0.802
Authors: Katarzyna Mitrega; Gregory Y H Lip; Beata Sredniawa; Adam Sokal; Witold Streb; Karol Przyludzki; Tomasz Zdrojewski; Lukasz Wierucki; Marcin Rutkowski; Piotr Bandosz; Jaroslaw Kazmierczak; Tomasz Grodzicki; Grzegorz Opolski; Zbigniew Kalarus Journal: J Clin Med Date: 2021-05-26 Impact factor: 4.241