Abstract 14499: Impact of Pre-existing and New Incident Atrial Fibrillation on Outcomes of Patients With Acute Pulmonary Embolism: Findings From an International Registry

BackgroundAtrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. MethodsUsing the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to...

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Published in:	Circulation (New York, N.Y.) Vol. 142; no. Suppl_3 Suppl 3; p. A14499
Main Authors:	Bikdeli, Behnood, Jimenez, David, Del Toro, Jorg, Piazza, Gregory, Rivas, Augussina, Fernández-Reyes, José Luis, Sampériz, Ángel, Otero, Remedios, Suriñach, José María, Siniscalchi, Carmine, Martín-Guerra, Javier Miguel, Castro, Joaquín, Muriel, Alfonso, Lip, Gregory, Goldhaber, Samuel Z, Monreal, Manuel
Format:	Journal Article
Language:	English
Published:	by the American College of Cardiology Foundation and the American Heart Association, Inc 17-11-2020
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Summary:	BackgroundAtrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. MethodsUsing the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to 01/2020), we identified three patient groups1) those with pre-existing AF 2) patients with newly identified AF within 2 days from the index PE (incident AF) and 3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, in unadjusted and multivariable adjusted models considering those without AF as referent. ResultsAmong 16,497 patients with PE, 792 had pre-existing AF. Compared with those without AF, patients with pre-existing AF, had increased odds of 90-day all-cause (Odds ratio [OR]2.81 (95% confidence interval [CI]2.33-3.38) and PE-related mortality (OR2.38, 95% CI1.37-4.14). After multivariable adjustment, pre-existing AF significantly increased the odds of all-cause mortality (OR1.91, 95% CI1.57-2.32) but not PE-related mortality (OR1.50; 95% CI0.85-2.66). Pre-existing AF was associated with increased hazard for ischemic stroke at 1-year follow-up (hazard ratio [HR]5.48; 95% CI3.10-9.69). Among 16,497 patients with PE, 445 developed incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR2.28; 95% CI1.75-2.97) and PE-related (OR3.64; 95% CI2.01-6.59) mortality. Findings were similar in multivariable analyses and at 1-year follow-up (Figure). No patients with incident AF developed ischemic stroke. ConclusionIn patients with acute symptomatic PE, both pre-existing AF and incident AF predict an adverse clinical course, although the type of adverse outcomes may be different depending on the timing of AF onset.
ISSN:	0009-7322 1524-4539
DOI:	10.1161/circ.142.suppl_3.14499