Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Eur J Clin Invest. 2022 Jul;52(7):e13773. doi: 10.1111/eci.13773. Epub 2022 Mar 28.
The management of patients with atrial fibrillation (AF) and malignancy is challenging given the paucity of evidence supporting their appropriate clinical management.
To evaluate the outcomes of patients with active or prior malignancy in a contemporary cohort of European AF patients.
Patients enrolled in the EURObservational Research Programme in AF General Long-Term Registry were categorized into 3 categories: No Malignancy (NoMal), Prior Malignancy (PriorMal) and Active Malignancy (ActiveMal). The primary outcomes were all-cause death and the composite outcome MACE.
A total of 10 383 patients were analysed. Of these, 9597 (92.4%) were NoMal patients, 577 (5.6%) PriorMal and 209 (2%) ActiveMal. Lack of any antithrombotic treatment was more prevalent in ActiveMal patients (12.4%) as compared to other groups (5.0% vs 6.3% for PriorMal and NoMal, p < .001). After a median follow-up of 730 days, there were 982 (9.5%) deaths and 950 (9.7%) MACE events. ActiveMal was independently associated with a higher risk for all-cause death (HR 2.90, 95% CI 2.23-3.76) and MACE (HR 1.54, 95% CI 1.03-2.31), as well as any haemorrhagic events and major bleeding (OR 2.42, 95% CI 1.49-3.91 and OR 4.18, 95% CI 2.49-7.01, respectively). Use of oral anticoagulants was not significantly associated with a higher risk for all-cause death or bleeding in ActiveMal patients.
In a large contemporary cohort of AF patients, active malignancy was independently associated with all-cause death, MACE and haemorrhagic events. Use of anticoagulants was not associated with a higher risk of all-cause death in patients with active malignancies.
由于缺乏支持房颤（AF）和恶性肿瘤患者适当临床管理的证据，因此管理患有房颤和恶性肿瘤的患者具有挑战性。
评估当代欧洲 AF 患者队列中患有活动性或既往恶性肿瘤的患者的结局。
入组 EURObservational Research Programme in AF General Long-Term Registry 的患者分为 3 类：无恶性肿瘤（NoMal）、既往恶性肿瘤（PriorMal）和活动性恶性肿瘤（ActiveMal）。主要结局为全因死亡和复合终点 MACE。
共分析了 10383 例患者。其中，9597 例（92.4%）为 NoMal 患者，577 例（5.6%）为 PriorMal 患者，209 例（2%）为 ActiveMal 患者。与其他两组相比，ActiveMal 患者更常未接受任何抗血栓治疗（12.4% vs PriorMal 和 NoMal 组的 5.0%和 6.3%，p<0.001）。中位随访 730 天后，有 982 例（9.5%）死亡和 950 例（9.7%）MACE 事件。ActiveMal 与全因死亡（HR 2.90，95%CI 2.23-3.76）和 MACE（HR 1.54，95%CI 1.03-2.31）风险增加独立相关，以及任何出血事件和大出血（OR 2.42，95%CI 1.49-3.91 和 OR 4.18，95%CI 2.49-7.01）。在 ActiveMal 患者中，使用口服抗凝剂与全因死亡或出血风险增加无关。
在大型当代 AF 患者队列中，活动性恶性肿瘤与全因死亡、MACE 和出血事件独立相关。在患有活动性恶性肿瘤的患者中，使用抗凝剂与全因死亡风险增加无关。
