Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis.
Am Heart J. 2008 Nov;156(5):855-863.e2
Authors: Goto S, Bhatt DL, Röther J, Alberts M, Hill MD, Ikeda Y, Uchiyama S, D'Agostino R, Ohman EM, Liau CS, Hirsch AT, Mas JL, Wilson PW, Corbalán R, Aichner F, Steg PG,
BACKGROUND: Atrial fibrillation (AF) is a major risk factor (RF) for ischemic stroke. Its prevalence and prognostic impact in patients with atherothrombosis are unclear. METHODS: Risk factors, drug usage, and 1-year cardiovascular (CV) outcomes (CV death, myocardial infarction [MI], and stroke) were compared in AF and non-AF patients from the REduction of Atherothrombosis for Continued Health (REACH) Registry, an international, prospective cohort of 68,236 stable outpatients with established atherothrombosis or >/=3 atherothrombotic RFs. RESULTS: Atrial fibrillation and 1-year follow-up data are available for 63,589 patients. The prevalence of AF was, 12.5%, 13.7%, 11.5%, and 6.2% among coronary artery disease, CV disease, peripheral artery disease, and RF-only patients, respectively. Of the 6,814 patients with AF, 6.7% experienced CV death, nonfatal MI, or nonfatal stroke within a year. The annual incidence of nonfatal stroke (2.4% vs 1.6%, P < .0001) and unstable angina (6.0% vs 4.0%, P < .00001) was higher, and CV death was more than double (3.2% vs 1.4%, P < .0001), in AF versus non-AF patients. In these patients with or at high risk of atherothrombosis, most patients with AF received antiplatelet agents, but only 53.1% were treated with oral anticoagulants. Even with high CHADS(2) (congestive heart failure, hypertension, aging, diabetes mellitus, and stroke) scores, anticoagulant use did not exceed (59%). The rate of bleeding requiring hospitalization was higher in AF versus non-AF patients (1.5% vs 0.8%, P < .0001), possibly related to the more frequent use of anticoagulants (53.1% vs 7.1%). CONCLUSIONS: Atrial fibrillation is common in patients with atherothrombosis, associated with more frequent fatal and nonfatal CV outcomes, and underuse of oral anticoagulants.
PMID: 19061698 [PubMed - as supplied by publisher]