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Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes
BACKGROUND: Atrial high rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs) are associated with an increased risk of stroke. However, the impact of AHRE on improving stroke risk stratification scheme remains uncertain. OBJECTIVE: The purpose of this study was to assess t...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694071/ https://www.ncbi.nlm.nih.gov/pubmed/30759274 http://dx.doi.org/10.1007/s00392-019-01432-y |
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author | Miyazawa, Kazuo Pastori, Daniele Li, Yan-Guang Székely, Orsolya Shahid, Farhan Boriani, Giuseppe Lip, Gregory Y. H. |
author_facet | Miyazawa, Kazuo Pastori, Daniele Li, Yan-Guang Székely, Orsolya Shahid, Farhan Boriani, Giuseppe Lip, Gregory Y. H. |
author_sort | Miyazawa, Kazuo |
collection | PubMed |
description | BACKGROUND: Atrial high rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs) are associated with an increased risk of stroke. However, the impact of AHRE on improving stroke risk stratification scheme remains uncertain. OBJECTIVE: The purpose of this study was to assess the impact of AHRE on prognosis in relation with cardiovascular events and risk stratification. METHODS: A total of 856 consecutive patients who had dual-chamber CIEDs implanted were retrospectively analyzed. To detect AHREs, they were monitored for 6 months after CIEDs’ implantation and were followed for a mean of 4.0 years for clinical outcomes such as thromboembolism or death. RESULTS: Overall, 125 (14.6%) of patients developed AHREs within the first 6 months (median age 72.0 years, 39.3% female). Patients with AHREs had a high rate of thromboembolism (2.6%/year) and mortality (3.0%/year). On multivariate analysis, AHRE was significantly associated with increased risk of thromboembolism [hazard ratio (HR) 3.40; 95% confidence interval (CI) 1.38–8.37, P = 0.01] and death (HR 3.47; 95% CI 1.51–7.95; P < 0.01). The predictive abilities of the CHADS(2) and CHA(2)DS(2)-VASc scores were modest, with no significant improvements by adding AHRE to those scores. However, the integrated discrimination improvement and net reclassification improvement showed that the addition of AHRE to the CHADS(2) and CHA(2)DS(2)-VASc scores statistically improved their predictive ability for the composite outcome. CONCLUSIONS: AHRE was an independent factor associated with increased risk of clinical outcomes. The addition of AHRE to the clinical risk scores significantly improved discrimination for thromboembolism or death. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00392-019-01432-y) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6694071 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-66940712019-08-28 Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes Miyazawa, Kazuo Pastori, Daniele Li, Yan-Guang Székely, Orsolya Shahid, Farhan Boriani, Giuseppe Lip, Gregory Y. H. Clin Res Cardiol Original Paper BACKGROUND: Atrial high rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs) are associated with an increased risk of stroke. However, the impact of AHRE on improving stroke risk stratification scheme remains uncertain. OBJECTIVE: The purpose of this study was to assess the impact of AHRE on prognosis in relation with cardiovascular events and risk stratification. METHODS: A total of 856 consecutive patients who had dual-chamber CIEDs implanted were retrospectively analyzed. To detect AHREs, they were monitored for 6 months after CIEDs’ implantation and were followed for a mean of 4.0 years for clinical outcomes such as thromboembolism or death. RESULTS: Overall, 125 (14.6%) of patients developed AHREs within the first 6 months (median age 72.0 years, 39.3% female). Patients with AHREs had a high rate of thromboembolism (2.6%/year) and mortality (3.0%/year). On multivariate analysis, AHRE was significantly associated with increased risk of thromboembolism [hazard ratio (HR) 3.40; 95% confidence interval (CI) 1.38–8.37, P = 0.01] and death (HR 3.47; 95% CI 1.51–7.95; P < 0.01). The predictive abilities of the CHADS(2) and CHA(2)DS(2)-VASc scores were modest, with no significant improvements by adding AHRE to those scores. However, the integrated discrimination improvement and net reclassification improvement showed that the addition of AHRE to the CHADS(2) and CHA(2)DS(2)-VASc scores statistically improved their predictive ability for the composite outcome. CONCLUSIONS: AHRE was an independent factor associated with increased risk of clinical outcomes. The addition of AHRE to the clinical risk scores significantly improved discrimination for thromboembolism or death. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00392-019-01432-y) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2019-02-13 2019 /pmc/articles/PMC6694071/ /pubmed/30759274 http://dx.doi.org/10.1007/s00392-019-01432-y Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Paper Miyazawa, Kazuo Pastori, Daniele Li, Yan-Guang Székely, Orsolya Shahid, Farhan Boriani, Giuseppe Lip, Gregory Y. H. Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes |
title | Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes |
title_full | Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes |
title_fullStr | Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes |
title_full_unstemmed | Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes |
title_short | Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes |
title_sort | atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694071/ https://www.ncbi.nlm.nih.gov/pubmed/30759274 http://dx.doi.org/10.1007/s00392-019-01432-y |
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