Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis

Shinya Goto, Deepak L. Bhatt, Joachim Röther, Mark Alberts, Michael D. Hill, Yasuo Ikeda, Shinichiro Uchiyama, Ralph D'Agostino, E. Magnus Ohman, Chiau Suong Liau, Alan T. Hirsch, Jean Louis Mas, Peter W.F. Wilson, Ramón Corbalán, Franz Aichner, P. Gabriel Steg

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242 Scopus citations


Background: Atrial fibrillation (AF) is a major risk factor (RF) for ischemic stroke. Its prevalence and prognostic impact in patients with atherothrombosis are unclear. Methods: Risk factors, drug usage, and 1-year cardiovascular (CV) outcomes (CV death, myocardial infarction [MI], and stroke) were compared in AF and non-AF patients from the REduction of Atherothrombosis for Continued Health (REACH) Registry, an international, prospective cohort of 68,236 stable outpatients with established atherothrombosis or ≥3 atherothrombotic RFs. Results: Atrial fibrillation and 1-year follow-up data are available for 63,589 patients. The prevalence of AF was, 12.5%, 13.7%, 11.5%, and 6.2% among coronary artery disease, CV disease, peripheral artery disease, and RF-only patients, respectively. Of the 6,814 patients with AF, 6.7% experienced CV death, nonfatal MI, or nonfatal stroke within a year. The annual incidence of nonfatal stroke (2.4% vs 1.6%, P < .0001) and unstable angina (6.0% vs 4.0%, P < .00001) was higher, and CV death was more than double (3.2% vs 1.4%, P < .0001), in AF versus non-AF patients. In these patients with or at high risk of atherothrombosis, most patients with AF received antiplatelet agents, but only 53.1% were treated with oral anticoagulants. Even with high CHADS2 (congestive heart failure, hypertension, aging, diabetes mellitus, and stroke) scores, anticoagulant use did not exceed (59%). The rate of bleeding requiring hospitalization was higher in AF versus non-AF patients (1.5% vs 0.8%, P < .0001), possibly related to the more frequent use of anticoagulants (53.1% vs 7.1%). Conclusions: Atrial fibrillation is common in patients with atherothrombosis, associated with more frequent fatal and nonfatal CV outcomes, and underuse of oral anticoagulants.

Original languageEnglish (US)
Pages (from-to)855-863.e2
JournalAmerican Heart Journal
Issue number5
StatePublished - Nov 2008

Bibliographical note

Funding Information:
Prof Goto has received honoraria and consulting fees from Bristol-Myers Squibb (Princeton, NJ) and sanofi-aventis (Paris, France). Prof Goto also received a research grant from sanofi-aventis within the last 3 years.

Funding Information:
Professor Ohman has received grant support from Bristol-Myers Squibb and sanofi-aventis.


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