Causes of death in patients with atrial fibrillation anticoagulated with rivaroxaban: a pooled analysis of XANTUS.

IF 7.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Europace Pub Date : 2024-07-02 DOI:10.1093/europace/euae183

Paulus Kirchhof, Sylvia Haas, Pierre Amarenco, Alexander G G Turpie, Miriam Bach, Marc Lambelet, Susanne Hess, A John Camm

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引用次数: 0

Abstract

Aims: Anticoagulation can prevent stroke and prolong lives in patients with atrial fibrillation (AF). However, anticoagulated patients with AF remain at risk of death. The aim of this study was to investigate the causes of death and factors associated with all-cause and cardiovascular death in the XANTUS population.

Methods and results: Causes of death occurring within a year after rivaroxaban initiation in patients in the XANTUS programme studies were adjudicated by a central adjudication committee and classified following international guidance. Baseline characteristics associated with all-cause or cardiovascular death were identified. Of 11 040 patients, 187 (1.7%) died. Almost half of these deaths were due to cardiovascular causes other than bleeding (n = 82, 43.9%), particularly heart failure (n = 38, 20.3%) and sudden or unwitnessed death (n = 24, 12.8%). Fatal stroke (n = 8, 4.3%), which was classified as a type of cardiovascular death, and fatal bleeding (n = 17, 9.1%) were less common causes of death. Independent factors associated with all-cause or cardiovascular death included age, AF type, body mass index, left ventricular ejection fraction, hospitalization at baseline, rivaroxaban dose, and anaemia.

Conclusion: The overall risk of death due to stroke or bleeding was low in XANTUS. Anticoagulated patients with AF remain at risk of death due to heart failure and sudden death. Potential interventions to reduce cardiovascular deaths in anticoagulated patients with AF require further investigation, e.g. early rhythm control therapy and AF ablation.

Trial registration numbers: NCT01606995, NCT01750788, NCT01800006.

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使用利伐沙班进行抗凝治疗的心房颤动患者的死亡原因：XANTUS 的汇总分析。

目的：抗凝治疗可预防中风并延长心房颤动（房颤）患者的生命；然而，抗凝治疗的房颤患者仍有死亡风险。本研究旨在调查 XANTUS 研究对象的死亡原因以及与全因死亡和心血管死亡相关的因素：XANTUS项目研究中的患者在开始使用利伐沙班后一年内的死亡原因由中央裁定委员会裁定，并按照国际指南进行分类。在11040名患者中，有187人（1.7%）死亡。其中近一半的死亡原因是出血以外的心血管疾病（82例，43.9%），尤其是心力衰竭（38例，20.3%）和猝死或无目击者死亡（24例，12.8%）。致命中风（8 人，4.3%）被归类为心血管死亡的一种，致命出血（17 人，9.1%）是不太常见的死亡原因。与全因或心血管死亡相关的独立因素包括年龄、房颤类型、体重指数、左心室射血分数、基线住院、利伐沙班剂量和贫血：XANTUS的中风或出血导致死亡的总体风险较低。抗凝房颤患者仍有因心力衰竭和猝死而死亡的风险。需要进一步研究减少抗凝房颤患者心血管死亡的潜在干预措施，如早期节律控制疗法和房颤消融术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Europace 医学-心血管系统

CiteScore

10.30

自引率

8.20%

发文量

851

审稿时长

3-6 weeks

期刊介绍： EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.