Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism
Bikdeli, Behnood (Cardiovascular Research Foundation)
Jiménez, David (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Del Toro, Jorge (Hospital General Universitario Gregorio Marañón)
Piazza, Gregory (Brigham and Women's Hospital (Boston, Estats Units d'Amèrica))
Rivas, Agustina (Arabako Unibertsitate Ospitalea)
Fernández-Reyes, José Luis (Complejo Hospitalario de Jaén)
Sampériz, Ángel (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Otero, Remedios (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Suriñach Caralt, José María (Hospital Universitari Vall d'Hebron)
Siniscalchi, Carmine (Azienda Ospedaliera Universitaria Parma)
Martín-Guerra, Javier Miguel (Hospital Clínico Universitario de Valladolid)
Castro, Joaquín (Hospital Santa Bárbara (Puertollano, Ciutat Real))
Muriel, Alfonso (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Lip, Gregory Y. H. (Aalborg Universitet)
Goldhaber, Samuel Z. (Brigham and Women's Hospital (Boston, Estats Units d'Amèrica))
Monreal, Manuel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2. 81; 95% CI, 2. 33-3. 38) and PE-related mortality (OR, 2. 38; 95% CI, 1. 37-4. 14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5. 48; 95% CI, 3. 10-9. 69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1. 91; 95% CI, 1. 57-2. 32) but not PE-related mortality (OR, 1. 50; 95% CI, 0. 85-2. 66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2. 28; 95% CI, 1. 75-2. 97) and PE-related (OR, 3. 64; 95% CI, 2. 01-6. 59) mortality but not stroke. Findings were similar in multivariable analyses. In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Atrial fibrillation ; Mortality ; Outcome ; Pulmonary embolism ; Thrombosis
Published in:	Journal of the American Heart Association. Cardiovascular and cerebrovascular disease, Vol. 10 (august 2021) , ISSN 2047-9980

DOI: 10.1161/JAHA.121.021467
PMID: 34459215

15 p, 873.4 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles