Quality of anticoagulation and outcomes after mechanical aortic valve replacement in patients with atrial fibrillation: a nationwide cohort study.

IF 4.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Quality of Care and Clinical Outcomes Pub Date : 2025-08-11 DOI:10.1093/ehjqcco/qcaf028

Joonas Lehto, Rikhard Björn, Olli Halminen, Miika Linna, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Janne Kinnunen, Juha Hartikainen, Juhani K E Airaksinen, Tuomas O Kiviniemi, Mika Lehto

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引用次数: 0

Abstract

Aims: Mechanical aortic valve replacement (AVR) remains the primary treatment for younger patients with severe aortic valve disease. However, limited information is available regarding the quality of the required lifelong vitamin K antagonist (VKA) therapy, atrial fibrillation (AF), and their relationship with adverse events after AVR. This study assessed the quality of VKA therapy prior to bleeding and ischaemic events following mechanical AVR in patients with AF.

Methods and results: The registry-based Finnish AntiCoagulation in Atrial Fibrillation study combining data from several Finnish healthcare registers covers all patients diagnosed with AF during 2007-18 in Finland. This analysis included patients undergoing mechanical AVR before or after the AF diagnosis. A total of 1086 patients with mechanical AVR and AF either before (41.2%) or after (58.8%) the operation were identified. Cumulative incidence estimates at 10 years after AVR were 27.9% for significant bleeding, 5.8% for intracranial haemorrhage, 12.8% for ischaemic stroke, and 7.2% for myocardial infarction. Time in therapeutic range (TTR) < 80% with international normalized ratio (INR) target 2.0-3.5 was associated with higher bleeding occurrence [adjusted hazard ratio (aHR) 1.97, 1.39-2.79, P < 0.001]. Time in therapeutic range with INR target ≥2.0 was associated with higher stroke occurrence (aHR/standard deviation 1.22, 1.01-1.46, P = 0.035). Mortality was high (28.9%/10 years), and TTR <80% was associated with higher mortality (aHR 2.74, 2.00-3.76, P < 0.001).

Conclusion: Adverse events, particularly major bleeding, are common in patients with AF following mechanical AVR, and mortality is high. Suboptimal TTR appears to predict bleeding episodes, ischaemic stroke, and death, and it could be useful in high-risk patient identification and targeting of preventive strategies.

Trial registration: Finnish AntiCoagulation in Atrial Fibrillation study, ClinicalTrials Identifier: NCT04645537, https://clinicaltrials.gov/ct2/show/NCT04645537.

查看原文本刊更多论文

心房颤动患者机械主动脉瓣置换术后抗凝质量和结果：一项全国性队列研究。

背景和目的：机械主动脉瓣置换术（AVR）仍然是严重主动脉瓣疾病年轻患者的主要治疗方法。然而，关于所需的终身维生素K拮抗剂（VKA）治疗，房颤（AF）的质量及其与AVR后不良事件的关系的信息有限。本研究评估了房颤患者机械性AVR后出血和缺血事件发生前VKA治疗的质量。方法：基于登记的FinACAF研究结合了芬兰几个医疗保健登记处的数据，涵盖了2007-2018年芬兰所有被诊断为房颤的患者。该分析包括在AF诊断之前或之后进行机械AVR的患者。结果：共有1086例机械性AVR合并AF患者在手术前（41.2%）和手术后（58.8%）被确诊。AVR后10年的累积发生率估计为：显著出血为27.9%，颅内出血为5.8%，缺血性脑卒中为12.8%，心肌梗死为7.2%。结论：不良事件，特别是大出血，在房颤患者机械性AVR后很常见，死亡率很高。次优TTR似乎可以预测出血发作、缺血性中风和死亡，它可以用于高风险患者的识别和预防策略的靶向。

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

European Heart Journal - Quality of Care and Clinical Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

3.80%

发文量

期刊介绍： European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.