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Thromb Haemost 2023; 123(05): 555-564
DOI: 10.1055/a-2009-8954
Atherosclerosis and Ischaemic Disease

Stroke and Myocardial Infarction in Patients with Abdominal Aortic Aneurysm and New-Onset Atrial Fibrillation

Chalotte W. Nicolajsen 
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
2   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
3   Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
,
Peter B. Nielsen
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
2   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
,
Martin Jensen
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
,
Nikolaj Eldrup
4   Department of Vascular Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
5   Copenhagen University, Copenhagen, Denmark
,
Torben B. Larsen
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
2   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
,
Gregory Y. H. Lip 
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
6   Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
,
Samuel Z. Goldhaber
7   Division of Cardiovascular Medicine, Thrombosis Research Group, Brigham and Women's Hospital, Boston, Massachusetts, United States
8   Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
,
Mette Søgaard
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
2   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
› Author Affiliations Funding This project received institutional support from the Obel Family Foundation, Denmark and research grant support from the Augustinus Foundation (Grant number 19–3672), Denmark, Jørgen Møller Foundation, Denmark, Karl G. Andersen Foundation, Denmark, and the Regional Health Research Foundation of North Jutland. The sponsors played no role in the study design; data collection, analysis, or interpretation; manuscript writing; or in the decision to submit the article for publication.
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Abstract

Objective We investigated the association between new-onset atrial fibrillation (AF) and risk of stroke and myocardial infarction (MI) in patients with abdominal aortic aneurysmal (AAA) disease.

Methods Observational crossover study using Danish nationwide data, including patients with AAA and incident AF between 1997 and 2018. We estimated the 1-year risk of stroke and MI and the within-individual odds ratios (ORs) of ischemic events before and after an AF diagnosis, stratified by year of AF diagnosis (1997–2010 and 2011–2018), and supplemented with analyses on changes in use of antithrombotic therapy.

Results A total of 3,035 AAA patients were included: 1,040 diagnosed during 1997 to 2010, and 1,995 during 2011 to 2018 (22.2% females, median age 78 years; median CHA2DS2-VASc score 4; interquartile range: 3–5). One-year risk of ischemic events after AF was 5.9% (confidence interval [CI] 95%: 4.6–7.5%) and 4.5% (CI 95%: 3.7–5.5%) for stroke and 5.4% (CI 95%: 4.2–6.9%) and 4.0% (CI 95%: 3.2–4.9%) for MI during 1997 to 2010 and 2011 to 2018, respectively. The OR of ischemic stroke before and after incident AF was 2.8 (CI 95%: 1.6–5.2) during 1997 to 2010; and 2.4 (CI 95%: 1.5 to 3.9) during 2011 to 2018, and 3.5 (CI 95%: 1.7–7.5) and 1.5 (CI 95%: 0.9–2.4) for MI. One-year proportion of prescription claims for oral anticoagulants after AF changed from 66.1% in 1997 to 2010 to 82.6% in 2011 to 2018, while antiplatelet prescription claims changed from 80.8 to 60.9%.

Conclusion Cardiovascular prognosis has improved in patients with prevalent AAA disease and new-onset AF in concordance with optimization of antithrombotic therapy over time. A diagnosis of AF conferred residual risk of stroke and MI.

Keywords

aortic aneurysm - abdominal - atrial fibrillation - stroke - myocardial infarction - risk assessment

Data Availability Statement

Because of the nonanonymized nature of the data collected for this study, requests to access the data set from third parties are not allowed according to Danish data safety regulations.


The review process for this paper was fully handled by Christian Weber, Editor in Chief.


Supplementary Material



Publication History

Received: 06 November 2022

Accepted: 07 January 2023

Accepted Manuscript online:
10 January 2023

Article published online:
20 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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