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  • Oxford University Press (OUP)  (3)
  • Lip, Gregory Y H  (3)
  • Pastori, Daniele  (3)
  • 1
    Online Resource
    Online Resource
    145 PREDICTION OF NEW ONSET ATRIAL FIBRILLATION IN PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION USING THE C2HEST AND MC2HEST SCORES A REPORT FROM THE MULTICENTER REALE-ACS REGISTRY
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal Supplements Vol. 24, No. Supplement_K ( 2022-12-15)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 24, No. Supplement_K ( 2022-12-15)
    Abstract: New onset atrial fibrillation (NOAF) is associated with worse clinical outcomes after acute coronary syndrome (ACS). Identification of patients at risk of NOAF remains challenging, and various clinical scores of varying complexities have been proposed to predict incident AF. We tested the value of the simple C2HEST score for predicting NOAF in patients with ACS. Methods We studied patients from the prospective ongoing multicenter REALE-ACS registry of patients with ACS. NOAF was the primary endpoint of the study. The C2HEST score was calculated as coronary artery disease or chronic obstructive pulmonary disease (1 point each), hypertension (1 point), elderly (age ≥75 years, 2 points), systolic heart failure (2 points), thyroid disease (1 point). We also tested the mC2HEST score. Results We enrolled 555 patients (mean age 65.6±13.3 years; 22.9% women), of which 45 (8.1%) developed NOAF. Patients with NOAF were older (p & lt;0.001) and had more prevalent hypertension (p=0.012), COPD (p & lt;0.001) and hyperthyroidism (p=0.018). Patients with NOAF were more frequently admitted with STEMI (p & lt;0.001), cardiogenic shock (p=0.008), Killip class ≥2 (p & lt;0.001) and had higher mean GRACE score (p & lt;0.001). Patients with NOAF had a higher C2HEST score compared with those without (4.2±1.7 vs 3.0±1.5, p & lt;0.001). A C2HEST score & gt;3 was associated with NOAF occurrence (odds ratio 4.33, 95% confidence interval 2.19-8.59, p & lt;0.001). ROC curve analysis showed good accuracy of the C2HEST score (AUC 0.71, 95%CI 0.67-0.74) and mC2HEST score in predicting NOAF (AUC 0.69, 95%CI 065-0.73). Conclusion The simple C2HEST score may be a useful tool to identify patients at higher risk of developing NOAF after presentation with ACS.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartjsupp/suac121.515
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2141255-8
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  • 2
    Online Resource
    Online Resource
    Real-world safety and efficacy of direct oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of 605 771 patients
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal - Cardiovascular Pharmacotherapy Vol. 7, No. FI1 ( 2021-04-09), p. f11-f19
    Details
    In: European Heart Journal - Cardiovascular Pharmacotherapy, Oxford University Press (OUP), Vol. 7, No. FI1 ( 2021-04-09), p. f11-f19
    Abstract: To analyse the safety and efficacy of direct oral anticoagulants (DOACs) in real-world studies including atrial fibrillation (AF) patients. Methods and results Systematic review and meta-analysis of observational studies including AF patients on DOACs. Primary endpoints: any, major, gastrointestinal (GI), intracranial haemorrhage (ICH), and haemorrhagic stroke (HS). Secondary endpoints: ischaemic stroke (IS), systemic embolism (SE), myocardial infarction (MI), and all-cause of death. A set of pair-wise meta-analyses using a random effect model and a random effect network meta-analysis under a Bayesian framework were performed. Prospero registration number: CRD42019137111. We included 21 studies with 605 771 AF patients. Apixaban was associated with lower major and GI bleeding compared with Rivaroxaban [hazard ratio (HR) 2.0, 95% confidence interval (CI) 1.6–2.5] and Dabigatran (HR 1.6, 95% CI 1.3–2.1). The latter drug performed better than Rivaroxaban (HR 1.2, 95% CI 1.0–1.5). Dabigatran and Apixaban had a similar association with HS, but Apixaban performed better than Rivaroxaban (HR 1.8, 95% CI 1.1–3.0). Apixaban had a similar association with Rivaroxaban and Dabigatran for ICH, the latter drug performing better than Rivaroxaban (HR 1.3, 95% CI 1.0–1.7). Rankograms showed that Apixaban was likely to be the first-choice treatment in relation to any (65%) major (100%) and GI bleeding (100%) followed by Dabigatran (46%, 100%, 99%, respectively). Dabigatran and Apixaban had similar rank as first choice for ICH (44% and 55%) and HS (52% and 48%). DOACs showed similar association with IS/SE, MI, all-cause of death. Conclusions Analysis of real-world studies shows significant differences for safety among DOACs.
    Type of Medium: Online Resource
    ISSN: 2055-6837 , 2055-6845
    URL: Article
    DOI: 10.1093/ehjcvp/pvab002
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2808613-2
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  • 3
    Online Resource
    Online Resource
    Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices
    Oxford University Press (OUP) ; 2022
    In:  EP Europace Vol. 24, No. 3 ( 2022-03-02), p. 375-383
    Details
    In: EP Europace, Oxford University Press (OUP), Vol. 24, No. 3 ( 2022-03-02), p. 375-383
    Abstract: Atrial high rate episodes (AHREs) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied. Methods and results This was an ancillary analysis of the multicentre, randomized IMPACT trial. In the present analysis, we classified patients according to the duration of AHRE ≤6 min, & gt;6 min to ≤6 h, & gt;6 to ≤24 h and & gt;24 h, and investigated the association between clinical factors and the development of each duration of AHRE. Of 2718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 5.4/100, 12.0/100, 6.8/100, and 3.3/100 patient-years, respectively. The incidence rates of AHRE & gt;6 h were significantly higher in patients at high risk of thromboembolism (CHADS2 score ≥3) compared to those at low risk (CHADS2 score 1 or 2). Using Cox regression analysis, age ≥65 years and history of atrial fibrillation (AF) and/or atrial flutter (AFL) were risk factors for AHRE & gt;6 min. In addition, hypertension was associated with AHRE & gt;24 h (hazard ratio 2.13, 95% confidence interval 1.24–3.65, P = 0.006). Conclusion Atrial high rate episode & gt;6 min to ≤6 h were most prevalent among all AHRE duration categories. Longer AHREs were more common in patients at risk of thromboembolism. Age and history of AF/AFL were risk factors for AHRE & gt;6 min. Furthermore, hypertension showed a strong impact on the development of AHRE & gt;24 h rather than age.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euab186
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2002579-8
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