TY - JOUR
T1 - Inadequate anticoagulation by Vitamin K Antagonists is associated with Major Adverse Cardiovascular Events in patients with atrial fibrillation
AU - Pastori, Daniele
AU - Pignatelli, Pasquale
AU - Saliola, Mirella
AU - Carnevale, Roberto
AU - Vicario, Tommasa
AU - Del Ben, Maria
AU - Cangemi, Roberto
AU - Barillà, Francesco
AU - Lip, Gregory Y.h.
AU - Violi, Francesco
PY - 2015/12/15
Y1 - 2015/12/15
N2 - Background
Time in therapeutic range (TTR) reflects the quality of anticoagulation and is inversely correlated with ischemic stroke in atrial fibrillation (AF) patients. Few data on the relationship between TTR and myocardial infarction (MI) are available. We investigated the association between TTR and Major Adverse Cardiovascular Events (MACE) in a cohort of anticoagulated AF patients.
Methods
We calculated TTR for 627 AF patients on vitamin K antagonists, who were followed for a median of 30.8 months (1755 patients/year). The primary outcome was a combined endpoint of MACE including fatal/nonfatal MI and cardiovascular death.
Results
Mean age was 73.3 (± 8.2) years, and 40.2% were women. During follow-up, we recorded 67 events: 19 stroke/TIA (1.1%/year) and 48 MACE (2.9%/year): 24 MI and 24 cardiovascular deaths. The cohort was categorized according to tertiles of TTR values: TTR 13–58%, 59–74%, and 75–100%. There was a significant increased rate of MACE across tertiles of TTR (Log-Rank test: p < 0.001). On Cox proportion hazard analysis, the 2nd vs. 1st tertile of TTR (p = 0.002, hazard ratio [HR] 0.347, confidence interval [CI] 95% 0.177–0.680), 3rd vs. 1st tertile of TTR (p < 0.001, HR 0.164, CI 95% 0.067–0.402), age (p < 0.001, HR 1.094, CI 95% 1.042–1.148), history of stroke/TIA (p = 0.015, HR 2.294, CI 95% 1.172–4.490) and smoking (p = 0.003, HR 3.450, CI 95% 1.532–7.769) predicted MACE.
Conclusion
TTR was an independent predictor of MACE in our cohort of AF patients. Our findings suggest that a good anticoagulation control is necessary to reduce not only the risk of stroke but also that of MACE.
AB - Background
Time in therapeutic range (TTR) reflects the quality of anticoagulation and is inversely correlated with ischemic stroke in atrial fibrillation (AF) patients. Few data on the relationship between TTR and myocardial infarction (MI) are available. We investigated the association between TTR and Major Adverse Cardiovascular Events (MACE) in a cohort of anticoagulated AF patients.
Methods
We calculated TTR for 627 AF patients on vitamin K antagonists, who were followed for a median of 30.8 months (1755 patients/year). The primary outcome was a combined endpoint of MACE including fatal/nonfatal MI and cardiovascular death.
Results
Mean age was 73.3 (± 8.2) years, and 40.2% were women. During follow-up, we recorded 67 events: 19 stroke/TIA (1.1%/year) and 48 MACE (2.9%/year): 24 MI and 24 cardiovascular deaths. The cohort was categorized according to tertiles of TTR values: TTR 13–58%, 59–74%, and 75–100%. There was a significant increased rate of MACE across tertiles of TTR (Log-Rank test: p < 0.001). On Cox proportion hazard analysis, the 2nd vs. 1st tertile of TTR (p = 0.002, hazard ratio [HR] 0.347, confidence interval [CI] 95% 0.177–0.680), 3rd vs. 1st tertile of TTR (p < 0.001, HR 0.164, CI 95% 0.067–0.402), age (p < 0.001, HR 1.094, CI 95% 1.042–1.148), history of stroke/TIA (p = 0.015, HR 2.294, CI 95% 1.172–4.490) and smoking (p = 0.003, HR 3.450, CI 95% 1.532–7.769) predicted MACE.
Conclusion
TTR was an independent predictor of MACE in our cohort of AF patients. Our findings suggest that a good anticoagulation control is necessary to reduce not only the risk of stroke but also that of MACE.
KW - Atrial fibrillation
KW - Myocardial infarction
KW - Warfarin
KW - Anticoagulant drugs
KW - Cardiovascular diseases
U2 - 10.1016/j.ijcard.2015.08.054
DO - 10.1016/j.ijcard.2015.08.054
M3 - Article
SN - 0167-5273
VL - 201
SP - 513
EP - 516
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -