Risk of Stroke or Systemic Embolism According to Baseline Frequency and Duration of Subclinical Atrial Fibrillation: Insights From the ARTESiA Trial

医学 心房颤动 阿哌沙班 危险系数 冲程(发动机) 内科学 阿司匹林 比例危险模型 心脏病学 亚临床感染 人口 置信区间 华法林 拜瑞妥 机械工程 工程类 环境卫生
作者
William F. McIntyre,Alexander P. Benz,Jeff S. Healey,Stuart J. Connolly,Mu Yang,Shun Fu Lee,Olga Rukovets,Marco Alings,Juan Bénézet-Mazuecos,Giuseppe Boriani,Jens Cosedis Nielsen,Michael R. Gold,Francesco Pergolini,Taya V. Glotzer,Christopher B. Granger,Renato D. Lópes
出处
期刊:Circulation [Ovid Technologies (Wolters Kluwer)]
标识
DOI:10.1161/circulationaha.124.069903
摘要

BACKGROUND: In the ARTESiA trial (Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation), apixaban, compared with aspirin, reduced stroke or systemic embolism in patients with device-detected subclinical atrial fibrillation (SCAF). Clinical guidelines recommend considering SCAF episode duration when deciding whether to prescribe oral anticoagulation for this population. METHODS: We performed a retrospective cohort study in ARTESiA. Using Cox regression adjusted for CHA 2 DS 2 -VASc score and treatment allocation (apixaban or aspirin), we assessed frequency of SCAF episodes and duration of the longest SCAF episode in the 6 months before randomization as predictors of stroke risk and of apixaban treatment effect. RESULTS: Among 3986 patients with complete baseline SCAF data, 703 (17.6%) had no SCAF episode ≥6 minutes in the 6 months before enrollment. Among 3283 patients (82.4%) with ≥1 episode of SCAF ≥6 minutes in the 6 months before enrollment, 2542 (77.4%) had up to 5 episodes, and 741 (22.6%) had ≥6 episodes. The longest episode lasted <1 hour in 1030 patients (31.4%), 1 to <6 hours in 1421 patients (43.3%), and >6 hours in 832 patients (25.3%). Higher baseline SCAF frequency was not associated with increased risk of stroke or systemic embolism: 1.1% for 1 to 5 episodes versus 1.2%/patient-year for ≥6 episodes (adjusted hazard ratio, 0.89 [95% CI, 0.59–1.34]). In an exploratory analysis, patients with previous SCAF but no episode ≥6 minutes in the 6 months before enrollment had a lower risk of stroke or systemic embolism than patients with at least one episode during that period (0.5% versus 1.1%/patient-year; adjusted hazard ratio, 0.48 [95% CI, 0.27–0.85]). The frequency of SCAF did not modify the reduction in stroke or systemic embolism with apixaban ( P interaction =0.1). The duration of the longest SCAF episode in the 6 months before enrollment was not associated with the risk of stroke or systemic embolism during follow-up (<1 hour: 1.0%/patient-year [reference]; 1–6 hours: 1.2%/patient-year [adjusted hazard ratio, 1.27 (95% CI, 0.85–1.90)]; >6 hours: 1.0%/patient-year [adjusted hazard ratio, 1.02 (95% CI, 0.63–1.66)]). SCAF duration did not modify the reduction in stroke or systemic embolism with apixaban ( P trend =0.1). CONCLUSIONS: In ARTESiA, baseline SCAF frequency and longest episode duration were not associated with risk of stroke or systemic embolism and did not modify the effect of apixaban on reduction of stroke or systemic embolism. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01938248.
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