Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction. Atrial fibrillation and mortality in an elderly population. Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction. The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: role of incorporating PR prolongation. Transient post-operative atrial fibrillation predicts short and long term adverse events following CABG. Incidence of myocardial infarction and vascular death in elderly patients with atrial fibrillation taking anticoagulants: relation to atherosclerotic risk factors. Impact of vascular disease in predicting stroke and death in patients with atrial fibrillation: the Danish Diet, Cancer and Health cohort study. Atrial fibrillation and the risk of myocardial infarction. Relationship of Sudden Cardiac Death to New-Onset Atrial Fibrillation in Hypertensive Patients With Left Ventricular Hypertrophy Apixaban in patients with atrial fibrillation and prior coronary artery disease: insights from the ARISTOTLE trial. Predictors of major adverse cardiovascular events; results of population based MELEN study with prospective follow-up. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. Long-term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH Registry. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation: insights from the RE-LY trial. Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials). Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. Should digoxin be proscribed in elderly subjects in sinus rhythm free from heart failure? A population-based study. Relation of recurrence of atrial fibrillation after non-ST-elevation acute myocardial infarction to left atrial abnormality. Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program. Evaluation of NT-proBNP and High Sensitivity C-Reactive Protein for Predicting Cardiovascular Risk in Patients with Arthritis Taking Longterm Nonsteroidal Antiinflammatory Drugs Anticoagulation Therapy in Atrial Fibrillation in Combination With Acute Myocardial Infarction Influences Long-Term Outcome: A Prospective Cohort Study From the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA)
BACKGROUND Atrial fibrillation ( AF ) is a major risk factor ( RF ) for ischemic stroke . Its prevalence and prognostic impact in patients with atherothrombosis are unclear . METHODS Risk factors , drug usage , and 1-year cardiovascular ( CV ) outcomes ( CV death , myocardial infa rct ion [ MI ] , and stroke ) were compared in  AF and non-AF patients from the REduction of Atherothrombosis for Continued Health ( REACH ) Registry , an international , prospect i ve cohort of 68,236 stable out patients with established atherothrombosis or > or=3 atherothrombotic RFs . RESULTS Atrial fibrillation and 1-year follow-up data are available for 63,589 patients . The prevalence of AF was , 12.5 % , 13.7 % , 11.5 % , and 6.2 % among coronary artery disease , CV disease , peripheral artery disease , and RF-only patients , respectively . Of the 6,814 patients with AF , 6.7 % experienced CV death , nonfatal MI , or nonfatal stroke within a year . The annual incidence of nonfatal stroke ( 2.4 % vs 1.6 % , P<.0001 ) and unstable angina ( 6.0 % vs 4.0 % , P<.00001 ) was higher , and CV death was more than double ( 3.2 % vs 1.4 % , P<.0001 ) , in AF versus non-AF patients . In these patients with or at high risk of atherothrombosis , most patients with AF received antiplatelet agents , but only 53.1 % were treated with oral anticoagulants . Even with high CHADS2 ( congestive heart failure , hypertension , aging , diabetes mellitus , and stroke ) scores , anticoagulant use did not exceed ( 59 % ) . The rate of bleeding requiring hospitalization was higher in AF versus non-AF patients ( 1.5 % vs 0.8 % , P<.0001 ) , possibly related to the more frequent use of anticoagulants ( 53.1 % vs 7.1 % ) . CONCLUSIONS Atrial fibrillation is common in patients with atherothrombosis , associated with more frequent fatal and nonfatal CV outcomes , and underuse of oral anticoagulants AIMS To characterize the relationship between known and newly diagnosed atrial fibrillation ( AF ) and the risk of death and major cardiovascular ( CV ) events in patients with acute myocardial infa rct ion ( MI ) complicated by heart failure ( HF ) and /or left ventricular systolic dysfunction ( LVSD ) . METHODS The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and /or LVSD .  AF was assessed at presentation and at r and omization ( median 4.9 days after symptom onset ) . Primary outcomes were risk of death and major CV events 3 years following acute MI . RESULTS A total of 1812 with current AF ( AF between presentation and r and omization ) , 339 patients with prior AF ( history of AF without current AF ) , and 12,509 without AF were enrolled . Patients with AF were older ; had more prior HF , angina , and MI , and received beta-blockers and thrombolytics less often than those without AF . Three-year mortality estimates were 20 % in those without AF , 37 % with current AF , and 38 % with prior AF . Compared with patients without AF , the multivariable adjusted HR of death was 1.25 ( 1.03 - 1.52 ; p=0.03 ) for prior AF and 1.32 ( 1.20 - 1.45 ; p<0.0001 ) for current AF . HR for major CV events was 1.15 ( 0.98 - 1.35 ; p=0.08 ) and 1.21 ( 1.12 - 1.31 ; p<0.0001 ) . CONCLUSION AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD Prospect i ve data from Busselton , Western Australia , collected during triennial surveys from 1966 - 81 with follow-up of subjects to 1983 , showed that atrial fibrillation ( AF ) was frequent in elderly people and associated with increased mortality . Of 1770 people aged over 60 years , 40 were in atrial fibrillation when first seen and a further 47 developed it during follow-up . Atrial fibrillation was positively associated with angina , history of a myocardial infa rct ion and left bundle branch block . Relative mortality in those with atrial fibrillation compared with those without it , was 1.92 for all causes , 1.82 for death from cardiovascular causes ( excluding stroke ) and 3.78 for deaths from stroke , after adjustment by proportional hazards regression for confounding effects of age , sex , history of a myocardial infa rct ion , an abnormal electrocardiogram , angina , cholesterol level systolic blood pressure and Quetelet 's Index ( weight/height2 ) . The excess relative mortality declined with increasing age for both women and men . This raised relative mortality remained constant with time from the first detection of AF for all causes and cardiovascular causes but appeared to increase with time from detection for stroke death . The risk of death from stroke was greatest in the younger women . The observed risk of death from stroke in patients with AF suggests that anticoagulant use should be considered in selected patients AIMS We investigated the prevalence of prior myocardial infa rct ion ( MI ) and incidence of ischaemic cardiovascular ( CV ) events among atrial fibrillation ( AF ) patients . METHODS AND RESULTS In ROCKET AF , 14 264 patients with nonvalvular AF were r and omized to rivaroxaban or warfarin . The key efficacy outcome for these analyses was CV death , MI , and unstable angina ( UA ) . This pre-specified analysis was performed on patients while on treatment . Rates are per 100 patient-years . Overall , 2468 ( 17 % ) patients had prior MI at enrollment . Compared with patients without prior MI , these patients were more likely to be male ( 75 vs. 57 % ) , on aspirin at baseline ( 47 vs. 34 % ) , have prior congestive heart failure ( 78 vs. 59 % ) , diabetes ( 47 vs. 39 % ) , hypertension ( 94 vs. 90 % ) , higher mean CHADS2 score ( 3.64 vs. 3.43 ) , and fewer prior strokes or transient ischaemic attacks ( 46 vs. 54 % ) . CV death , MI , or UA rates tended to be lower in patients assigned rivaroxaban compared with warfarin [ 2.70 vs. 3.15 ; hazard ratio ( HR ) 0.86 , 95 % confidence interval ( CI ) 0.73 - 1.00 ; P = 0.0509 ] . CV death , MI , or UA rates were higher in those with prior MI compared with no prior MI ( 6.68 vs. 2.19 ; HR 3.04 , 95 % CI 2.59 - 3.56 ) with consistent results for CV death , MI , or UA for rivaroxaban compared with warfarin in prior MI compared with no prior MI ( P interaction = 0.10 ) . CONCLUSION Prior MI was common and associated with substantial risk for subsequent cardiac events . Patients with prior MI assigned rivaroxaban compared with warfarin had a non-significant 14 % reduction of ischaemic cardiac events AIMS Atrial fibrillation ( AF ) is a common complication in patients with acute myocardial infa rct ion and is associated with an increase in the risk of death . The excess mortality associated with AF complicating acute myocardial infa rct ion has not been studied in detail . Observations indicate that AF facilitates induction of ventricular arrhythmias , which may increase the risk of sudden cardiovascular death ( SCD ) . A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments . METHODS AND RESULTS We analysed the relation between AF/atrial flutter ( AFL )  and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infa rct ion screened in the TR And olapril Cardiac Evaluation registry . This cohort of patients with an enzyme-verified acute myocardial infa rct ion was admitted to 27 centres in 1990 - 92 .  Survival status was obtained 2 years after screening of the last patient . An independent endpoint committee assessed the modes of death . Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospect ively collected . Sustained or paroxysmal AF/AFL was observed in 1149 patients ( 19 % ) during hospitalization . During follow-up , 1659 patients ( 34 % ) died : 482 ( 50 % ) patients with AF/AFL and 1177 ( 30 % ) patients without AF/AFL , P<0.001 . SCD occurred in 536 , non-SCD occurred in 725 , and 398 died of non-cardiovascular causes ( includes 142 unclassifiable cases ) . The adjusted risk ratio of AF/AFL for total mortality was 1.33 ( 95 % CI : 1.19 - 1.49 ; P<0.0001 ) and the risk ratio for SCD was 1.31 ( 95 % CI : 1.07 - 1.60 ; P<0.009 ) . The adjusted risk ratio of AF/AFL for non-SCD was 1.43 ( 95 % CI : 1.21 - 1.70 ; P<0.0001 ) . CONCLUSION The excess mortality observed in patients with AF/AFL following acute myocardial infa rct ion is due to a significant increase in both SCD and non-SCD OBJECTIVES To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular ( CV ) events among high-risk patients without atrial fibrillation ( AF ) , and the additional value of incorporating PR prolongation to the scores . METHODS We analyzed 579 high-risk CV out patients without clinical AF in a prospect i ve cohort for new-onset ischemic stroke , myocardial infa rct ion ( MI ) , congestive heart failure ( CHF ) , and CV death .  Brachial flow-mediated dilation ( FMD ) and nitroglycerin-mediated dilatation ( NMD ) , carotid intima-media thickness ( IMT ) and pulse wave velocity ( PWV ) were determined . RESULTS Baseline CHADS2 score was associated with lower FMD ( Pearson r = -0.16 , P < 0.001 ) and NMD ( r = -0.17 , P < 0.001 ) , higher carotid IMT ( r = 0.30 , P < 0.001 ) and PWV ( r = 0.35 , P < 0.001 ; similar for CHA2DS2-VASc score : All P < 0.05 ) . After follow-up of 63 ± 11 months , 82 patients ( 14.2 % ) developed combined CV endpoint . ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke ( C-Statistic : CHADS2 0.70 , P = 0.004 ; CHA2DS2-VASc 0.68 , P = 0.010 ) , MI ( CHADS2 0.63 , P = 0.030 ; CHA2DS2-VASc 0.70 , P = 0.001 ) , and CV death ( CHADS2 0.63 , P = 0.022 ; CHA2DS2-VASc 0.65 , P = 0.011 ) . Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints ( log-rank = 16.7 , P < 0.001 ) with differences potentiated if stratified by CHA2DS2-VASc score ( log-rank = 29.2 , P < 0.001 ) . Incorporating PR prolongation , the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction ( 0.70 , P < 0.001 ) superior to the CHADS2 score ( chi-square : 12.1 , P = 0.0005 ) . CONCLUSIONS The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF , with further improved performance incorporating PR prolongation OBJECTIVE To assess the relationship between the development of transient post-operative atrial fibrillation ( TPOAF ) following coronary artery bypass graft ( CABG ) surgery and risk of long-term mortality . BACKGROUND Atrial fibrillation ( AF ) following CABG is common and associated with increased morbidity and mortality in the perioperative period . However the impact of TPOAF and its management on long-term morbidity and mortality in patients undergoing first time , isolated CABG surgery remains unclear . METHODS The Clevel and Clinic Cardiovascular Information Registry was used to identify 5,205 consecutive patients who underwent CABG between January 1993 and December 2005 . Patients with TPOAF  ( n=1,490 ) were compared to those without post-operative AF ( n=3,645 ) for the endpoints of death , myocardial infa rct ion ( MI ) , or stroke at 1 year . RESULTS Overall rates of 1-year mortality , MI and stroke were 3.7 % , 0.8 % , and 2.6 % , respectively . Patients with TPOAF had an increased risk of death at 1 year as compared to patients without POAF ( 6.4 % vs. 2.7 % ; P<0.001 ) , but there was not an increased risk of stroke or MI . Multivariate analysis identified TPOAF as an independent predictor of death at 1 year ( HR 1.89 , 95 % CI , 1.42 - 2.53 ; P<0.001 ) . After propensity matching , patients who developed TPOAF experienced a significantly increased risk of death compared with those without TPOAF ( HR 1.96 , 95 % CI , 1.34 - 2.86 ; P<0.001 ) . CONCLUSIONS In patients undergoing first time , isolated CABG , the presence of TPOAF identifies a subgroup of patients at increased risk for all-cause mortality . Future prospect i ve studies to determine potential beneficial interventions in this large population are warranted BACKGROUND Recent findings suggest that patients with atrial fibrillation ( AF ) , in addition being at thromboembolic risk , are at risk of myocardial infa rct ion ( MI ) . Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants .  METHODS We prospect ively followed up 1,019 patients with AF for a median of 33.7 months ( 3,223 person-years ) . All patients were treated with oral vitamin K antagonists . Primary outcome was a composite end point of cardiovascular events ( CVEs ) including fatal/nonfatal MI , cardiac revascularization , and cardiovascular death . RESULTS The mean age of the patients was 73.2 years , and 43.8 % were women . At follow-up , 111 CVEs ( 3.43%/y ) had occurred : 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths . In addition , 31 stroke/transient ischemic attacks ( 0.96%/y ) were recorded . Patients experiencing CVEs were older ( P < .001 ) and had a higher prevalence of metabolic syndrome ( MetS ) ( P = .005 ) , heart failure ( P = .001 ) , and prior cardiac ( P < .001 ) and cerebrovascular events ( P < .001 ) . On a Cox proportional hazard analysis , age ( hazard ratio [ HR ] , 1.083 ; 95 % CI , 1.053 - 1.113 ; P < .001 ) , smoking ( HR , 2.158 ; 95 % CI , 1.193 - 3.901 ; P = .011 ) , history of cerebrovascular ( HR , 1.704 ; 95 % CI , 1.119 - 2.597 ; P = .013 ) and cardiac ( HR , 1.658 ; 95 % CI , 1.105 - 2.489 ; P = .015 ) events , MetS ( HR , 1.663 ; 95 % CI , 1.107 - 2.499 ; P = .014 ) , heart failure ( HR , 1.584 ; 95 % CI , 1.021 - 2.456 ; P = .040 ) , and male sex ( HR , 1.499 ; 95 % CI , 1.010 - 2.223 ; P = .044 ) predicted CVEs . CONCLUSIONS Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment . MetS is a common clinical feature in patients with AF , which increases the risk of CVEs . A holistic approach is needed to reduce the cardiovascular risk in patients with AF . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01882114 ; URL : www . clinical trials.gov BACKGROUND The presence of vascular disease ( peripheral artery disease [ PAD ] and /or myocardial infa rct ion [ MI ] ) may impact on the risk of stroke and death among patients with incident atrial fibrillation ( AF ) . To test this hypothesis , we analyzed data from a large Danish prospect i ve cohort , the Danish Diet , Cancer and Health ( DCH ) study , to assess the risk of stroke or death among those who developed AF according to concomitant presence of vascular disease . METHODS A prospect i ve cohort study of 57 , 053 persons ( 27 , 178 men and 29 , 876 women , respectively ) , aged between 50 and 64 years . The risk of stroke or death for patients with vascular disease was assessed amongst 3315 patients with incident AF ( mean age , 67.1years ; 2130 men , 1185 women ) using Cox proportional hazard models , after a median follow-up of 4.8 years . RESULTS Of the subjects with AF , 417 ( 12.6 % ) had ' vascular disease ' ( PAD and /or prior MI ) . The risk of the primary endpoint ( stroke or death ) was significantly higher in patients with vascular disease at 1-year follow-up ( crude hazard ratio [ HR ] 2.51 [ 1.91 - 3.29 ] ) , with corresponding crude HRs for PAD and MI being 3.51 ( 2.40 - 5.13 ) , and 1.99 ( 1.46 - 2.72 ) , respectively . For the secondary endpoints of death or stroke individually , these risk estimates were similar ( crude HR 2.48 [ 1.89 - 3.26 ] and 1.77 [ 1.18 - 2.66 ] , respectively ) . After adjustment for risk factors within the CHADS(2 ) score , the adjusted HR for the primary endpoint ( stroke or death ) in patients with vascular disease was 1.91 ( 1.44 - 2.54 ) , which was also significant for death ( 1.97 [ 1.48 - 2.62 ] ) . CONCLUSION Vascular disease ( prior MI and PAD ) is an independent risk factor for the primary endpoint of ' stroke or death ' in patients with AF , even after adjustment for the CHADS(2 ) risk score , although this is driven by the impact on mortality . This reaffirms that patients with vascular disease represent a ' high-risk ' population , which necessitates proactive management of all cardiovascular risk factors and effective thromboprophylaxis ( i.e. oral anticoagulation ) , which has been shown to significantly reduce the risk of stroke and death in AF IMPORTANCE Myocardial infa rct ion ( MI ) is an established risk factor for  atrial fibrillation ( AF ) .  However , the extent to which AF is a risk factor for MI has not been investigated . OBJECTIVE To examine the risk of incident MI associated with AF . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve cohort of 23,928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke ( REGARDS ) cohort between 2003 and 2007 , with follow-up through December 2009 . MAIN OUTCOMES AND MEASURES Expert-adjudicated total MI events ( fatal and nonfatal ) . RESULTS Over 6.9 years of follow-up ( median 4.5 years ) , 648 incident MI events occurred . In a sociodemographic-adjusted model , AF was associated with about 2-fold increased risk of MI ( hazard ratio [ HR ] , 1.96 [ 95 % CI , 1.52 - 2.52 ] ) . This association remained significant ( HR , 1.70 [ 95 % CI , 1.26 - 2.30 ] ) after further adjustment for total cholesterol , high-density lipoprotein cholesterol , smoking status , systolic blood pressure , blood pressure-lowering drugs , body mass index , diabetes , warfarin use , aspirin use , statin use , history of stroke and vascular disease , estimated glomerular filtration rate , albumin to creatinine ratio , and C-reactive protein level . In subgroup analysis , the risk of MI associated with AF was significantly higher in women ( HR , 2.16 [ 95 % CI , 1.41 - 3.31 ] ) than in men ( HR , 1.39 [ 95 % CI , 0.91 - 2.10 ] ) and in blacks ( HR , 2.53 [ 95 % CI , 1.67 - 3.86 ] ) than in whites ( HR , 1.26 [ 95 % CI , 0.83 - 1.93 ] ) ; for interactions , P = .03 and P = .02 , respectively . On the other h and , there were no significant differences in the risk of MI associated with AF in older ( ≥75 years ) vs younger ( < 75 years ) participants ( HR , 2.00 [ 95 % CI , 1.16 - 3.35 ] and HR , 1.60 [ 95 % CI , 1.11 - 2.30 ] , respectively ) ; for interaction , P = .44 . CONCLUSIONS AND RELEVANCE AF is independently associated with an increased risk of incident MI , especially in women and blacks . These findings add to the growing concerns of the seriousness of AF as a public health burden : in addition to being a well-known risk factor for stroke , AF is also associated with increased risk of MI Background —Prevalent atrial fibrillation ( AF ) is associated with a higher sudden cardiac death ( SCD ) rate in some population s , and incident AF predicts increased mortality risk in the general population and after myocardial infa rct ion . However , the relationship of SCD to new-onset AF is unclear . Methods and Results —The relationship of SCD to new-onset AF was evaluated in 8831 hypertensive patients with electrocardiographic left ventricular hypertrophy with no history of AF , in sinus rhythm on their baseline electrocardiogram , r and omly assigned to losartan- or atenolol-based treatment . During 4.7±1.1 years mean follow-up , new-onset AF occurred in 701 patients ( 7.9 % ) and SCD in 151 patients ( 1.7 % ) . In univariate Cox analyses , new-onset AF was associated with a > 4-fold higher risk of SCD ( hazard ratio , 4.69 ; 95 % CI interval , 2.96–7.45 ; P<0.001 ) . In multivariate Cox analyses adjusting for age , sex , race , diabetes mellitus , history of heart failure , myocardial infa rct ion , ischemic heart disease , stroke , smoking , serum high-density lipoprotein cholesterol , creatinine , glucose , and urine albumin/creatinine ratio as st and ard risk factors , and for incident myocardial infa rct ion , in-treatment use of digoxin , systolic and diastolic pressure , heart rate , QRS duration , Cornell voltage- duration product , and Sokolow-Lyon voltage left ventricular hypertrophy treated as time-varying covariates , new-onset AF remained associated with a > 3-fold increased risk of SCD ( hazard ratio , 3.13 ; 95 % confidence interval , 1.87–5.24 ; P<0.001 ) . Conclusions —Development of new-onset AF identifies hypertensive patients at  increased risk of SCD . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00338260 BACKGROUND A substantial portion of patients with atrial fibrillation ( AF ) also have coronary artery disease ( CAD ) and are at risk for coronary events . Warfarin is known to reduce these events , but increase the risk of bleeding . We assessed the effects of apixaban compared with warfarin in AF patients with and without prior CAD . METHODS AND RESULTS In ARISTOTLE , 18,201 patients with AF were r and omized to apixaban or warfarin .  History of CAD was defined as documented CAD , prior myocardial infa rct ion , and /or history of coronary revascularization . We analyzed baseline characteristics and clinical outcomes of patients with and without prior CAD and compared outcomes by r and omized treatment using Cox models . A total of 6639 ( 36.5 % ) patients had prior CAD . These patients were more often male , more likely to have prior stroke , diabetes , and hypertension , and more often received aspirin  at baseline ( 42.2 % vs. 24.5 % ) . The effects of apixaban were similar among patients with and without prior CAD on reducing stroke or systemic embolism and death from any cause ( hazard ratio [ HR ] 0.95 , 95 % confidence interval [ CI ] 0.71 - 1.27 , P for interaction=0.12 ; HR 0.96 , 95 % CI 0.81 - 1.13 , P for interaction=0.28 ) . Rates of myocardial infa rct ion were numerically lower with apixaban than warfarin among patients with and without prior CAD . The effect of apixaban on reducing major bleeding and intracranial hemorrhage was consistent in patients with and without CAD . CONCLUSIONS In patients with AF , apixaban more often prevented stroke or systemic embolism and death and caused less bleeding than warfarin , regardless of the presence of prior CAD . Given the common occurrence of AF and CAD and the higher rates of cardiovascular events and death , our results indicate that apixaban may be a better treatment option than warfarin for these high-risk patients OBJECTIVE In healthy persons , cardiovascular risk is the result of multiple interacting risk associates including demographic , clinical , genetic and environmental factors . Several non-invasive tools such as echocardiography , ultrasonography and electrocardiography as well as new biochemical markers were shown to be applicable to predict cardiovascular events . However , implementation of all of these tools has not been tested before . The aim of the study was to evaluate the independent predictors of major adverse cardiovascular events in a prospect i ve population based study , with the use of bioempedance analysis , echocardiography , ultrasonography and ECG . PATIENTS AND METHODS The baseline measurements were conducted on 2230 participants ( 1427 women , 803 men with a mean age of 49 ± 15 ) . The follow-up was done 36 months after the baseline admission via telephone call . Major adverse event was defined as mortality or myocardial infa rct ion or stroke . RESULTS Follow-up data was possible in 1495 participants ( 65 % ) . During the follow-up of 36 months ( 4485 patient years ) , 42 major adverse events occurred ( 0.03 % ) . Among them , 16 were death ( 1 stroke , 2 cancer , 13 cardiac related ) , 12 were stroke and 14 were myocardial infa rct ion . Age , body mass index and atrial fibrillation were independent predictors of major adverse events ; AF being the most powerful ( Odds ratio 10.46 ; 95 % confidence interval [ 1.73 - 63.14 ] ; p = 0.010 ) . CONCLUSIONS Age , lower body mass index and atrial fibrillation were independent predictors of major cardiovascular events in our cohort Atrial fibrillation ( AF ) has been established as an independent predictor of long-term mortality after acute myocardial infa rct ion . However , this is less well defined across the whole spectrum of acute coronary syndromes ( ACSs ) . The Acute Coronary Syndrome Prospect i ve Audit is a prospect i ve multicenter registry with 12-month outcome data for 3,393 patients ( 755 with ST-segment elevation myocardial infa rct ion , 1942 with high-risk non-ST-segment elevation ACS [ NSTE-ACS ] , and 696 with intermediate-risk NSTE-ACS ) . A total of 149 patients ( 4.4 % ) had new-onset AF and 387 ( 11.4 % ) had previous AF .  New-onset AF was more , and previous AF was less frequent in those with ST-segment elevation myocardial infa rct ion than in those with high-risk NSTE-ACS or intermediate-risk NSTE-ACS ( p < 0.001 ) . Compared to patients without arrhythmia , patients with new-onset AF and previous AF were significantly older and had more high-risk features at presentation ( p < 0.004 ) . Patients with new-onset AF more often had left main coronary artery disease , result ing in a greater rate of surgical revascularization ( p < 0.001 ) . Only new-onset AF result ed in adverse in-hospital outcomes ( p < 0.001 ) . Only patients with previous AF had greater long-term mortality ( hazard ratio 1.42 , p < 0.05 ) . New-onset AF was only associated with a worse long-term composite outcome ( hazard ratio 1.66 , p = 0.004 ) . However , the odds ratio for the composite outcome was greatest for patients with new-onset AF with intermediate-risk NSTE-ACS ( odds ratio 3.9 , p = 0.02 ) than for those with high-risk NSTE-ACS ( odds ratio 2.0 , p = 0.01 ) or ST-segment elevation myocardial infa rct ion ( odds ratio 1.4 , p = 0.4 ) . In conclusion , new-onset AF was associated with worse short-term outcomes and previous AF was associated with greater mortality even at long-term follow-up . The prognostic burden of new-onset AF differed with the type of ACS presentation BACKGROUND Patients with atrial fibrillation ( AF )  are at increased risk of thromboembolic events . The long-term prognostic implication s of AF in patients with atherothrombosis are unknown . METHODS We compared 4-year CV outcomes in patients with and without a history of AF recorded at their baseline visit in the REACH Registry , an international , prospect i ve cohort of patients with established atherosclerotic arterial disease ( CAD , CVD , PAD ) or at least 3 risk factors ( RFO ) . RESULTS AF status and 4 year follow-up data were available on 44,518 patients . The prevalence of AF at baseline was 10.3 % ( n=4582 ) . Overall , patients with AF had approximately a 2-fold increase in the composite of CV death , MI , or stroke compared with patients without AF after adjustment for age , gender , prior ischemic event , vascular disease , congestive heart failure , diabetes , smoking , body mass index , region , aspirin and statin use ( 18.9 % vs. 9.4 % , p<0.0001 ) . This increased risk was observed both in patients with established atherothrombosis ( CAD : 15.5 % vs. 8.0 % , p=0.0001 ; CVD : 23.6 % vs. 13.6 % , p<0.0001 ; PAD : 24.3 % vs. 13.5 % , p=0.089 ) and those with multiple risk factors ( RFO : 12.1 % vs. 5.9 % , p=0.017 ) . Only 52 % of patients with a history of AF at baseline were receiving anticoagulation at 4 years . CONCLUSIONS Patients with a history of both AF and atherothrombosis have particularly high long-term CV risk . Despite this increased risk , almost half of all patients with AF do not receive guideline recommended anticoagulation , highlighting an important public health priority BACKGROUND Anemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation ( AF ) . OBJECTIVES To investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF . PATIENTS AND METHODS We retrospectively analyzed the RE-LY trial data base , which r and omized 18 113 patients with AF and a risk of stroke to receive dabigatran or warfarin for a median follow-up of 2 years .  Cox regression analysis was used to determine whether anemia predicted cardiovascular events and bleeding complications in these patients . RESULTS Anemia was present in 12 % of the population at baseline , and the presence of anemia was associated with a higher risk of thromboembolic cardiovascular events , including the composite endpoint of all-cause mortality or myocardial infa rct ion ( adjusted hazard ratio [ HR ] 1.50 , 95 % confidence interval [ CI ] 1.32 - 1.71 ) and the primary RE-LY outcome of stroke or systemic embolism ( adjusted HR 1.41 , 95 % CI 1.12 - 1.78 ) . Anemia was also associated with a higher risk of major bleeding complications ( adjusted HR 2.14 , 95 % CI 1.87 - 2.46 ) and discontinuation of anticoagulants ( adjusted HR 1.40 , 95 % CI 1.28 - 1.79 ) . The association between anemia and outcome was similar irrespective of cardiovascular comorbidities , r and omized treatment allocation , or prior use of warfarin . The incidence of events was lower in patients with transient anemia than in patients in whom anemia was sustained ( adjusted HR 0.66 , 95 % CI 0.49 - 0.91 ) . CONCLUSIONS Anemia is associated with an increased risk of thromboembolic events , bleeding complications and mortality in anticoagulated patients with AF . These findings suggest that patients with anemia should be monitored closely during all types of anticoagulant treatment Obesity is well-established as a major cardiovascular ( CV ) risk factor . Obesity confers a greater risk for developing atrial fibrillation ( AF ) , but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear . To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF , their influence on adverse events , and the relation with anticoagulation control , we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation ( SPORTIF ) III and V data sets . For this study , we analyzed all patients assigned to the warfarin arm with data on body mass index ( BMI ) . Time in therapeutic range was used as an index of the quality of anticoagulation control . The 3,630 patients eligible for this analysis were categorized as follows : ( 1 ) BMI 18.5 to 24.9 ( " normal weight " ) in 24.1 % ; ( 2 ) BMI 25.0 to 29.9 ( " overweight " ) in 39.8 % ; and BMI ≥30 ( " obese " ) in 36.1 % . Both overweight ( hazard ratio [ HR ] 0.70 ) and obese ( HR 0.59 ) categories were inversely associated with the composite outcome of stroke/all-cause death . A similar inverse association was seen for the end point of stroke ( HR 0.61 and 0.47 , respectively ) . Good anticoagulation control also attenuated the association between BMI categories and outcomes . In patients with time in therapeutic range > 70 % , BMI category was not significantly associated with the composite outcome of stroke/death and stroke . Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF . The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control OBJECTIVES We sought to determine if echocardiography enhances prediction of first age-related cardiovascular events . BACKGROUND Whether echocardiographic assessment improves risk stratification for first cardiovascular events is not well known . METHODS This retrospective cohort study included r and omly selected residents of Olmsted County , Minnesota , age > /=65 years , who had > /=1 transthoracic echocardiograms at the Mayo Clinic between 1990 and 1998 , in sinus rhythm , without valvular or congenital heart disease , and followed through medical records for first myocardial infa rct ion ( MI ) , coronary revascularization , atrial fibrillation ( AF ) , congestive heart failure ( CHF ) , transient ischemic attack ( TIA ) , stroke , or cardiovascular death . Patients were excluded if they had any of these events before the baseline echocardiogram . RESULTS Of 1,160 patients ( age 75 + /- 7 years ; 746 women ) followed for a mean of 3.8 + /- 2.7 years , 333 ( 29 % ) first events occurred ( 70 AF , 67 coronary revascularization procedures , 65 CHF , 48 MI , 38 stroke , 25 TIA , and 20 cardiovascular deaths ) . In a multivariate model , age ( p < 0.001 ) , male gender ( p < 0.001 ) , diabetes mellitus ( p = 0.005 ) , systemic hypertension ( p < 0.001 ) , left atrial volume/body surface area > /=32 ml/m(2 ) ( p = 0.003 ) , left ventricular ( LV ) mass/height > /=120 g/m ( p = 0.014 ) , LV systolic dysfunction ( p < 0.001 ) , and LV diastolic dysfunction ( p = 0.029 ) were independent predictors . A risk-scoring algorithm was developed and vali date d for the prediction of first events . The five-year event-free survival was 90 % , 74 % , and 50 % for low- , medium- , and high-risk groups , respectively . CONCLUSIONS Echocardiography enhanced prediction of first cardiovascular events in this referral-based elderly cohort . Its role in risk stratification for primary prevention of these events in the community warrants further investigations Increased mortality in digoxin-treated subjects has been demonstrated in patients with recent myocardial infa rct ion . Those with congestive heart failure ( CHF ) due to causes other than myocardial infa rct ion seem to be free from this effect . No information is currently available concerning mortality in elderly people who are frequently prescribed digitalis even in the absence of CHF . The aim of this study was to investigate whether subjects improperly receiving digoxin were worse off than those not receiving this drug . This analysis is a part of CASTEL , a population -based prospect i ve study that has enrolled a cohort of 2,254 subjects aged > or = 65 years . CHF was diagnosed in 187 subjects and atrial fibrillation ( AF ) in 90 . The remaining 1,977 were free from CHF and in sinus rhythm , but 447 were treated with digitalis .  Cumulative mortality and morbid events by digitalis treatment were calculated in all these categories . Among subjects free from CHF and AF ( improper use ) , all-cause and cardiovascular mortality was significantly higher among those taking digitalis than in those who did not . Non-fatal events including CHF were also more apparent in the former than in the latter . Cox analysis confirmed digitalis as a predictor of mortality in these subjects . No effect of digitalis on survival was found in patients with CHF or AF ( proper use ) . In elderly subjects without atrial fibrillation or CHF , the use of digitalis worsens morbidity and mortality Atrial fibrillation ( AF ) is common during the course of acute myocardial infa rct ion and is associated with left atrial ( LA ) dilatation . However , the role of LA depolarization abnormality on the  electrocardiogram ( ECG ) in the setting of LA dilatation was not studied in this context . Patients admitted with non-ST-segment elevation myocardial infa rct ion ( NSTEMI ) who developed new-onset AF ( International Classification of Diseases , Ninth Revision code 427.31 ) were prospect ively identified . Baseline ECGs and echocardiograms before the admission event were review ed . Follow-up was directed toward pertinent cardiovascular events , atrial tachyarrhythmias , and death as end points . Of 101 patients with NSTEMI who had new-onset AF , 88 had current echocardiograms and 69 had LA dilatation ( 78 % ) . Total follow-up was 24 months ( mean 21.4 ) . Prolonged P-wave duration ( > or = 110 ms ) and decreased left ventricular fractional shortening were most significant in those with LA dilatation and were independently associated with AF . In those with LA dilatation , the prevalence of such abnormal atrial depolarization on ECGs was 56 % . AF ( 43 % vs 15 % ; p = 0.03 ) and heart failure ( 63 % vs 35 % ; p = 0.03 ) occurred more often in this subset , but there was no difference in mortality . However , the overall prevalence of late cardiovascular complications in this subset was higher ( 71 % vs 45 % ; p = 0.02 ) compared with that of immediate complications ( 20 % vs 26 % ; p = 0.60 ) . In conclusion , there is higher recurrence of AF in patients with NSTEMI who have a combination of electrocardiographic and echocardiographic LA abnormalities compared with those without OBJECTIVES We assessed the risk of adverse cardiovascular ( CV ) outcomes associated with atrial fibrillation ( AF ) in the C and esartan in Heart failure- Assessment of Reduction in Mortality and morbidity ( CHARM ) program , which enrolled patients with chronic heart failure ( CHF ) and a broad range of ejection fractions ( EFs ) . BACKGROUND Atrial fibrillation is associated with an increased risk of adverse CV outcomes in patients with CHF and reduced EF . The risk of AF in patients with CHF and preserved left ventricular ejection fraction ( PEF ) is unknown . METHODS A total of 7,599 patients with symptomatic CHF were r and omized to c and esartan or placebo . Patients were divided by baseline EF ( < or = 40 % or > 40 % ) in low or preserved EF groups . Major outcomes were cardiovascular death or hospitalization for worsening heart failure , and all-cause mortality . Median follow-up was 37.7 months . RESULTS A total of 670 ( 17 % ) patients in the low EF group and 478 ( 19 % ) in the PEF group had AF at baseline . Atrial fibrillation predicted a high risk of cardiovascular morbidity and mortality regardless of baseline EF . Patients with AF and low EF had the highest absolute risk for adverse CV outcomes . However , AF was associated with greater relative increased risk of the major outcomes in patients with PEF than in patients with low EF : hazard ratio 1.72 ( 95 % confidence interval [ CI ] 1.45 to 2.06 ) versus 1.29 ( 95 % CI 1.14 to 1.46 ) , respectively . The same was true for the risk of all-cause mortality . C and esartan was associated with similar treatment effects regardless of baseline rhythm . CONCLUSIONS Atrial fibrillation is associated with an increased risk of CV outcomes in patients with CHF and either reduced EF or PEF . C and esartan improved outcomes similarly regardless of baseline rhythm Objective . Patients with arthritis frequently are at increased risk for future cardiovascular ( CV ) events . We investigated the performance of the cardiac biomarkers N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) and high sensitivity C-reactive protein ( hsCRP ) for predicting CV events in patients with arthritis taking chronic nonsteroidal antiinflammatory drugs ( NSAID ) . Methods . We evaluated 2-year CV outcomes in a prospect i ve , nested biomarker study among patients ( N = 6273 ) with rheumatoid arthritis and osteoarthritis treated with NSAID in the MEDAL ( Multinational Etoricoxib and Diclofenac Arthritis Long-term ) trial . Patients were stratified by quartiles of baseline NT-proBNP and established cutpoints of NT-proBNP and hsCRP . Results . NT-proBNP demonstrated a strong grade d relationship with CV outcomes , including CV death ( p for trend < 0.0001 ) , myocardial infa rct ion ( MI ) ( p for trend = 0.02 ) , heart failure ( HF ) ( p for trend < 0.0001 ) , and a composite of thrombotic events ( CV death , MI , stroke ) or HF ( p for trend < 0.0001 ) . Baseline levels of hsCRP were not associated with CV events ( CV death/MI/stroke/HF ; p for trend = 0.65 ) . NT-proBNP remained strongly predictive of CV events after adjustment for age , sex , diabetes , hypertension , hyperlipidemia , smoking , type of arthritis , body mass index , creatinine clearance , history of CV disease , and hsCRP ( CV death/MI/stroke/HF : Q4 vs Q1 hazard ratio 3.53 , 95 % CI 1.89−6.58 ) . Patients with a NT-proBNP level below 100 pg/ml had a 0.94 % rate of thrombotic events or heart failure at 2 years . Conclusion . NT-proBNP is a simple and robust noninvasive indicator of CV risk in patients with arthritis . Risk stratification based on NT-proBNP may facilitate identification of patients with arthritis who are at low CV risk during chronic NSAID  treatment Background — The American and European guidelines do not agree with regard to antithrombotic treatment in patients with atrial fibrillation ( AF ) and acute myocardial infa rct ion ( AMI ) , thus causing uncertainty among physicians . We investigated the prescription of oral anticoagulation ( OAC ) in patients discharged alive with AF after an AMI and the influence of OAC treatment on 1-year mortality . Methods and Results — This was a prospect i ve cohort study using data from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions ( RIKS-HIA ) on patients admitted to the coronary care units of 72 Swedish hospitals from 1995 to 2002 . A total of 6182 patients discharged alive with first registry-recorded AMI and AF on discharge ECG were included . One-year mortality data were obtained from the Swedish National Cause of Death Register . Only 30 % ( n=1848 ) of the 6182 patients with AF were prescribed OAC . At 1 year , the unadjusted mortality was 31 % ( 1183 deaths ) in the platelet-inhibitors only group and 22 % ( 414 deaths ) in the OAC-treated group . In Cox regression analysis with adjustment for confounding factors , OAC treatment was associated with a reduction in 1-year mortality ( relative risk 0.73 ; 95 % CI 0.62 to 0.86 ; P<0.001 ) in hospital survivors of AMI with AF . The reduction in mortality appeared to be caused primarily by a lower rate of ischemic heart death ( 55.6 % versus 62.0 % ) and fatal stroke ( 5.7 % versus 7.5 % ) in the OAC group . This reduction of mortality was similar among most subgroups based on age , sex , baseline characteristics , previous disease manifestations , and medications . Conclusions — In daily clinical practice , OAC was only given to a minority ( 30 % ) of AMI patients with AF , despite the fact that OAC was associated with a 29 % relative and 7 % absolute reduction in 1-year mortality after adjustment for confounding variables . The results emphasize the importance of OAC treatment for AF after AMI
These results showed that AF is an independent risk factor for MI , CV death , and CV events
This study aim ed to investigate whether  atrial fibrillation ( AF ) predicts myocardial infa rct ion ( MI ) or cardiovascular ( CV ) death .
AF is a well-established risk factor for thrombotic stroke and all-cause mortality .