Document Detail


Atrial Fibrillation and Aortic Stenosis: Impact on Clinical Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation.
MedLine Citation:
PMID:  23386662     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: ATRIAL FIBRILLATION (AF) IS AN IMPORTANT RISK FACTOR FOR STROKE AND IS COMMON AMONG ELDERLY PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION. THE AIM OF THIS STUDY WAS TO ASSESS THE IMPACT OF AF ON CLINICAL OUTCOMES AMONG PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION.METHODS AND RESULTS: BETWEEN AUGUST 2007 AND OCTOBER 2011, A TOTAL OF 389 HIGH-RISK PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION WERE INCLUDED INTO A PROSPECTIVE REGISTRY. AF WAS RECORDED IN 131 PATIENTS (33.7%) WITH A MEAN CHA(2)DS(2)VASC SCORE OF 4.51.2 AND WAS PAROXYSMAL IN 26 (25.0%), PERSISTENT IN 8 (7.7%), AND PERMANENT IN 70 PATIENTS (67.3%). PATIENTS WITH AND WITHOUT AF HAD SIMILAR BASELINE CHARACTERISTICS EXCEPT FOR FEWER REVASCULARIZATION PROCEDURES (CORONARY ARTERY BYPASS GRAFTING: 12% VERSUS 22%; P=0.03) AMONG AF PATIENTS. AT 1 YEAR, ALL-CAUSE MORTALITY WAS HIGHER AMONG PATIENTS WITH AF (30.9%) COMPARED WITH THOSE WITHOUT AF (13.9%; HAZARD RATIO [HR], 2.36; 95% CONFIDENCE INTERVAL [CI], 1.433.90; P=0.0008). THIS WAS OBSERVED IRRESPECTIVE OF THE TYPE OF AF (PERMANENT, HR, 2.47; 95% CI, 1.404.38; PERSISTENT, HR, 3.60; 95% CI, 1.1011.78; PAROXYSMAL, HR, 2.88; 95% CI, 1.376.05). MORTALITY GRADUALLY INCREASED WITH HIGHER CHA(2)DS(2)VASC SCORES (SCORE 13: HR, 2.20; 95% CI, 0.925.27; SCORE 68: HR, 4.12; 95% CI, 2.078.20). THE RISKS OF STROKE (3.9% VERSUS 5.1%; HR, 0.76; 95% CI, 0.231.96; P=0.47) AND LIFE-THREATENING BLEEDING (19.8% VERSUS 14.7%; HR, 1.37; 95% CI, 0.862.19; P=0.19) WERE SIMILAR AMONG PATIENTS WITH AND WITHOUT AF.CONCLUSIONS: AF is common among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and is associated with a >2-fold increased risk of all-cause and cardiovascular mortality, irrespective of the type of AF. The gradient of risk directly correlates with the CHA(2)DS(2)-VASC score.
Authors:
Stefan Stortecky; Lutz Buellesfeld; Peter Wenaweser; Dik Heg; Thomas Pilgrim; Ahmed A Khattab; Steffen Gloekler; Christoph Huber; Fabian Nietlispach; Bernhard Meier; Peter Jüni; Stephan Windecker
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-5
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Departments of Cardiology and Cardiovascular Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; and Department of Clinical Research, Clinical Trials Unit, Bern, Switzerland.
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