Petersen Jeppe Kofoed, Fosbøl Emil Loldrup, Strange Jarl Emanuel, Schou Morten, Brems Daniel Alexander, Køber Lars, Østergaard Lauge
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.
Int J Cardiol Heart Vasc. 2023 Jul 6;47:101239. doi: 10.1016/j.ijcha.2023.101239. eCollection 2023 Aug.
The prognostic implications of new-onset atrial fibrillation (AF) in conjunction with transcatheter aortic valve replacement (TAVR) is sparsely examined. Therefore, we aimed to examine the impact of first-time detected AF after TAVR on all-cause mortality and heart failure (HF).
With Danish nationwide data from 2008 to 2021, we identified all patients who underwent TAVR and were alive 30 days after discharge (index date). Patients were categorized into i) no AF; ii) history of AF; and iii) first-time detected AF within 30 days after discharge. From the index date, two-year rates of all-cause mortality and HF admissions were compared using multivariable adjusted Cox analysis.
We identified 6,807 patients surviving 30 days beyond TAVR: 4,229 (62.1%) without AF (55% male, median age 81), 2,283 (33.6%) with history of AF (58% male, median age 82), and 291 (4.3%) with first-time detected AF (56% male, median age 81). Compared with patients without AF, adjusted analysis yielded increased associated hazard ratio (HR) of all-cause mortality in patients with history of AF (1.53 [95% confidence interval [CI], 1.32-1.77]) and in patients with first-time detected AF (2.06 (95%CI, 1.55-2.73]). Further, we observed increased associated HRs of HF admissions in patients with history of AF (1.70 [95%CI, 1.45-1.99]) and in patients with first-time detected AF (1.77 [95%CI, 1.25-2.50]).
In TAVR patients surviving 30 days beyond discharge, first-time detected AF appeared to be at least as strongly associated with two-year rates of all-cause mortality and HF admissions, as compared with patients with history of AF.
新发房颤（AF）与经导管主动脉瓣置换术（TAVR）相关的预后影响鲜有研究。因此，我们旨在研究TAVR后首次检测到的房颤对全因死亡率和心力衰竭（HF）的影响。
利用丹麦2008年至2021年的全国性数据，我们确定了所有接受TAVR且出院后30天仍存活（索引日期）的患者。患者被分为：i）无房颤；ii）有房颤病史；iii）出院后30天内首次检测到房颤。从索引日期开始，使用多变量调整的Cox分析比较全因死亡率和HF住院率的两年发生率。
我们确定了6807例TAVR后存活30天以上的患者：4229例（62.1%）无房颤（男性55%，中位年龄81岁），2283例（33.6%）有房颤病史（男性58%，中位年龄82岁），291例（4.3%）首次检测到房颤（男性56%，中位年龄81岁）。与无房颤患者相比，调整分析显示有房颤病史患者的全因死亡率相关风险比（HR）增加（1.53[95%置信区间[CI]，1.32 - 1.77]），首次检测到房颤的患者相关风险比增加（2.06[95%CI，1.55 - 2.73]）。此外，我们观察到有房颤病史患者的HF住院相关风险比增加（1.70[95%CI，1.45 - 1.99]），首次检测到房颤的患者相关风险比增加（1.77[95%CI，1.25 - 2.50]）。
在出院后存活30天以上的TAVR患者中，与有房颤病史的患者相比，首次检测到的房颤似乎与全因死亡率和HF住院率的两年发生率至少同样密切相关。
