O.S. Sychov, A.O. Borodai, E.S. Borodai. Predictors of cardiovascular outcomes in patients with non-valvular atrial fibrillation and flutter

The aim – to evaluate predictors of cardiovascular outcomes in patients with non-valvular atrial fibrillation and flutter, to evaluate influence of medical therapy and adherence to therapy on their reduction.

Material and methods. In prospective observational study with mean follow up of 38.7±2.4 months we recruited 271 patients with atrial fibrillation and flutter. The primary endpoint was occurrence of ischemic stroke / ТІА and the combined end point (CEP) was stroke / TIA, peripheral embolism or death of any cause.

Results. Among 271 patient 46 (16.96 %) reached CEP and among them 27 (9.96 %) experienced ischemic stroke/TIA. In multivariate model spontaneous echo contrast 3–4+ and CHA2DS2-VASc were independent predictors of ischemic stroke and CEP (P<0.05 for both). Рermanent AF, class EHRAm III–IV and diameter of interventricular septum ≥ 1.7 sm were also independently associated with stroke. In patients with CHA2DS2-VASc ≥ 2, anticoagulants usage was associated with significant reduction of stroke compared to aspirin or no drugs (hazard ratio (HR) 0,23 (95 % CI 0.1–0.63), Р=0.002). On the other hand we haven’t found any reduction of stroke in aspirin patients compared to no drugs. Moreover, anticoagulation was associated with reduction of CEP compared to aspirin or no drugs (HR 0.33 (95 % CI 0.17–0.66), Р=0.0001). Adherence to recommendations for anticoagulation therapy was associated with reduction of stroke. There was reduction of CEP in the rhythm control group, comparing to rate control group (5 (6.17 %), vs 21 (21.2 %) appropriately, HR 0.29 (95 % CI 0.11–0.72), Р=0,001). Conclusions. In patient with CHA2DS2-VASc ≥ 2 anticoagulation therapy and adherence to its recommendations was associated with significant reduction of ischemic stroke and CEP. Rhythm control was associated with reduction of CEP.

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