Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials.

Autor:	Schnabel RB; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.; Atrial Fibrillation NETwork (AFNET), Mendelstraße 11, 48149 Muenster, Germany., Benezet-Mazuecos J; Cardiology Department, Hospital Universitario La Luz, Madrid, Spain., Becher N; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany., McIntyre WF; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada., Fierenz A; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Lee SF; Department of Health Research Methods, Evaluation, and Impact, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada., Goette A; Department of Cardiology and Intensive Care Medicine, St Vincenz-Hospital Paderborn, Paderborn, Germany.; Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany., Atar D; Division of Cardiology, Oslo University Hospital Ulleval, and Institute of Clinical Medicine, University of Oslo, Norway., Bertaglia E; Cardiology Unit, Camposampiero Hospital-AULSS, Padua, Italy., Benz AP; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.; Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany., Chlouverakis G; Biostatistics Lab, School of Medicine, University of Crete, Crete, Greece., Birnie DH; University of Ottawa Heart Institute, Ottawa, ON, Canada., Dichtl W; Department of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria., Blomstrom-Lundqvist C; Department of Medical Science, Uppsala University, Uppsala, Sweden.; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Camm AJ; Cardiovascular and Cell Sciences Research Institute, St George´s, University of London, London, UK., Erath JW; Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt, Germany., Simantirakis E; Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece., Kutyifa V; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA., Lip GYH; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Mabo P; Cardiology and Vascular Disease Division, Rennes University Health Centre, Rennes, France., Marijon E; Cardiology Division, European Georges Pompidou Hospital, Paris, France., Rivard L; Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montréal, Canada., Schotten U; Atrial Fibrillation NETwork (AFNET), Mendelstraße 11, 48149 Muenster, Germany.; Departments of Cardiology and Physiology, Maastricht University, Maastricht, The Netherlands., Alings M; Amphia Ziekenhuis, Breda, Netherlands., Sehner S; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Toennis T; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany., Linde C; Department of Cardiology, Karolinska Institutet, Stockholm, Sweden., Vardas P; Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece.; Biomedical Research Foundation Academy of Athens (BRFAA), Greece and Hygeia Hospitals Group, Athens, Greece., Granger CB; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Zapf A; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Lopes RD; Duke Clinical Research Institute, Duke University, Durham, NC, USA., Healey JS; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada., Kirchhof P; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.; Atrial Fibrillation NETwork (AFNET), Mendelstraße 11, 48149 Muenster, Germany.; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Dec 07; Vol. 45 (46), pp. 4902-4916.
DOI:	10.1093/eurheartj/ehae596
Abstrakt:	Background and Aims: The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation. Methods: These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death. Results: In patients with vascular disease (NOAH-AFNET 6, 56%; ARTESiA, 46%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6, 2.7%/patient-year; ARTESiA, 2.3%/patient-year in both randomized groups). Meta-analysis found consistent results across both trials (I2heterogeneity = 6%) with a trend for interaction with randomized therapy (pinteraction = .08). Stroke/SE behaved similarly. Anticoagulation equally increased major bleeding in vascular disease patients [edoxaban, 2.1%/patient-year; no anticoagulation, 1.3%/patient-year; apixaban, 1.7%/patient-years; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.55 (1.10-2.20)] and without vascular disease [edoxaban, 2.2%/patient-year; no anticoagulation, 0.6%/patient-year; apixaban, 1.4%/patient-year; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.93 (0.72-5.20)]. Conclusions: Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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