| Autor: |
Bikdeli B; Cardiovascular Medicine Division Brigham and Women's HospitalHarvard Medical School Boston MA.; Yale/YNHH Center for Outcomes Research & Evaluation New Haven CT.; Cardiovascular Research Foundation (CRF) New York NY., Jiménez D; Respiratory Department Hospital Ramón y Cajal (IRYCIS) Madrid Spain.; Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain.; CIBER de Enfermedades Respiratorias (CIBERES) Madrid Spain., Del Toro J; Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain., Piazza G; Cardiovascular Medicine Division Brigham and Women's HospitalHarvard Medical School Boston MA., Rivas A; Department of Pneumonology Hospital Universitario Araba Álava Spain., Fernández-Reyes JL; Department of Internal Medicine Complejo Hospitalario de Jaén Jaén Spain., Sampériz Á; Department of Internal Medicine Hospital Reina Sofía Tudela, Navarra Spain., Otero R; Department of Pneumonology Hospital Universitario Virgen del Rocío Seville Spain., Suriñach JM; Department of Internal Medicine Hospital Universitario Vall d'Hebron Barcelona Spain., Siniscalchi C; Department of Angiology Azienda Ospedaliera Universitaria Parma Italy., Martín-Guerra JM; Department of Internal Medicine Hospital Clínico Universitario de Valladolid Valladolid Spain., Castro J; Department of Internal Medicine Hospital Santa Bárbara Puertollano, Ciudad Real Spain., Muriel A; Clinical Biostatistics Unit Hospital Universitario Ramón y CajalIRYCISCIBERESP: Universidad de Alcalá Madrid Spain., Lip GYH; Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom.; Thrombosis Research Unit Aalborg University Aalborg Denmark., Goldhaber SZ; Cardiovascular Medicine Division Brigham and Women's HospitalHarvard Medical School Boston MA., Monreal M; Hospital Universitari Germans Trias i Pujol Badalona, Barcelona Spain.; Universidad Autónoma de Barcelona Spain. |
| Abstrakt: |
Background 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. Methods and Results 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. Conclusions 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. |
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