Risk of myocardial infarction and ischemic stroke in individuals with first-diagnosed paroxysmal vs. non-paroxysmal atrial fibrillation under anticoagulation

Abstract

Aims There is conflicting evidence on whether the type of atrial fibrillation (AF) is associated with risk of cardiovascular events, including acute myocardial infarction (MI) and ischemic stroke. The aim of the present study was to investigate whether the risk of MI and ischemic stroke differs between individuals with first-diagnosed paroxysmal vs. non-paroxysmal AF treated with anticoagulants. Methods and results De-identified electronic medical records from the TriNetX federated research network were used. Individuals with a new diagnosis of paroxysmal AF who had no evidence of other types of AF in their records were 1:1 propensity score-matched with individuals with non-paroxysmal AF, defined as persistent or chronic AF, who had no evidence of other types of AF in their records. All patients were followed for three years for the outcomes of MI and ischemic stroke. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). In the propensity-matched cohort, among 24 848 well-matched AF individuals [mean age 74.4 ± 10.4; 10 101 (40.6%) female], 410 (1.7%) were diagnosed with acute MI and 875 (3.5%) with ischemic stroke during the three-year follow-up. Individuals with paroxysmal AF had significantly higher risk of acute MI (HR: 1.65, 95%CI: 1.35–2.01) compared to those with non-paroxysmal AF. First diagnosed paroxysmal AF was associated with higher risk of non-ST elevation MI (nSTEMI) (HR: 1.89, 95%CI: 1.44–2.46). No significant association was observed between the type of AF and risk of ischemic stroke (HR: 1.09, 95%CI: 0.95–1.25). Conclusion Patients with first-diagnosed paroxysmal AF had higher risk of acute MI compared to individuals with non-paroxysmal AF, attributed to the higher risk of nSTEMI among patients with first-diagnosed paroxysmal AF. There was no significant association between type of AF and risk of ischemic stroke.

Long duration of atrial high‐rate episode is more favorable in predicting ischemic stroke than high CHA2DS2‐VASc score

“…Multivariate regression analysis showed that the AHRE≥48 h could predict the stroke well ( p = .001). Similar result was found in a current propensity‐matched cohort study, and no significant association was observed between the type of AF and risk of ischemic stroke (HR: 1.09, 95%CI: 0.95–1.25) 26 . Should we modify the anticoagulant strategies based on AHRE? 27,28 More investigations is necessary in the future clinical trials.…”

Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network

“…The research on the TriNetX online research platform was performed on 26 November 2022 for patients aged ≥18 years with AF or flutter (ICD-10-CM code I48). As previously described, 17 the baseline index event was the first AF diagnosis reported into the TriNetX platform. Any medical diagnosis and cardiovascular procedures or treatment registered into the system within 5 years from the index event were considered as an individual baseline characteristic.…”

Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort

“…As its incidence and prevalence increase with age, it is estimated that about 17.9 million adults aged over 55 years in 2060 will experience AF in the European Union ( 3 ). Adjusting for age and predisposing conditions, AF has been associated with an increased risk of stroke ( 4 ), heart failure ( 5 ), myocardial infarction (MI) ( 6 ) and death ( 7 , 8 ). In addition, numerous previous studies, including several meta-analyses, provide growing evidence of an association between AF and cognitive decline in the absence of clinically overt previous stroke ( 9 , 10 ).…”