Association between rivaroxaban and the prognosis of patients with acute myocardial infarction and new-onset atrial fibrillation.

IF 2.7 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Yi Zheng, Ying Liu, Xinyu Zheng, Gary Tse, Gregory Y H Lip, Kang-Yin Chen, Tong Liu
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引用次数: 0

Abstract

Background: New-onset atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) is associated with higher risks of stroke and mortality. However, current guidelines lack specific antithrombotic recommendations for this population. This study aimed to explore the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF.

Methods: This retrospective cohort study included patients with AMI and new-onset AF receiving dual antiplatelet therapy between August 2016 and June 2023 in Tianjin, China. New-onset AF (transient or nontransient) was defined as the first diagnosis of AF following AMI. The primary outcome was stroke.

Results: 2477 patients were identified, including 141 rivaroxaban users and 2336 patients without oral anticoagulants (OAC). Over a median follow-up of 922 days, rivaroxaban users had a 5.7% lower risk of stroke than non-OAC users, although this was not statistically significant (19.9% vs. 25.6%; P = .152). Despite the suggestion of a protective trend, multivariable Cox regression showed that rivaroxaban use was not associated with a lower risk of stroke (hazard ratio, 0.77; 95% confidence interval, 0.52-1.13, P = .187). After propensity score matching, 155 transient (rivaroxaban: 42; non-OAC: 113) and 295 nontransient AF patients (rivaroxaban: 85; non-OAC: 210) were included. No significant association was observed between rivaroxaban and stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding.

Conclusion: No significant association was observed between rivaroxaban and clinical outcomes in patients with AMI and new-onset AF. Given the small sample size and limited statistical power, the findings are exploratory and require further validation. Key messages  What is already known on this topic: Evidence from previous studies indicates that acute myocardial infarction (AMI) patients with new-onset atrial fibrillation (AF) are associated with higher risks of ischemic stroke and mortality. However, the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF remains uncertain.  What this study adds: Among patients with AMI and new-onset AF receiving dual antiplatelet therapy, no significant differences were observed between rivaroxaban users and non-oral anticoagulant users in terms of the risks of stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding. However, these results should be interpreted with caution due to the small sample size and limited statistical power of the study.  How this study might affect research, practice or policy: Future prospective large-scale studies and randomized controlled trials are needed to further examine the role of rivaroxaban and other types of oral anticoagulants in patients with AMI and new-onset AF.

利伐沙班与急性心肌梗死和新发房颤患者预后的关系。
背景:急性心肌梗死(AMI)的新发心房颤动(AF)与卒中和死亡的高风险相关。然而,目前的指南缺乏针对这一人群的具体抗血栓建议。本研究旨在探讨利伐沙班与AMI和新发房颤患者预后的关系。方法:本回顾性队列研究纳入2016年8月至2023年6月在中国天津接受双重抗血小板治疗的AMI和新发房颤患者。新发房颤(一过性或非一过性)定义为AMI后首次诊断为房颤。主要结局是中风。结果:共纳入2477例患者,其中使用利伐沙班者141例,未使用口服抗凝剂(OAC)者2336例。在中位922天的随访中,利伐沙班使用者的卒中风险比非oac使用者低5.7%,尽管这没有统计学意义(19.9%对25.6%;P = 0.152)。尽管存在保护趋势,但多变量Cox回归显示,使用利伐沙班与卒中风险降低无关(风险比0.77;95%可信区间0.52-1.13,P = 0.187)。倾向评分匹配后,纳入155例短暂性(利伐沙班:42例,非oac: 113例)和295例非短暂性房颤患者(利伐沙班:85例,非oac: 210例)。未观察到利伐沙班与中风、缺血性中风、出血性中风、全因死亡率、心血管死亡率、出血或大出血之间的显著相关性。结论:利伐沙班与AMI和新发房颤患者的临床结局无显著相关性。由于样本量小,统计效力有限,研究结果具有探索性,需要进一步验证。关于该主题的已知信息:先前的研究证据表明,急性心肌梗死(AMI)合并新发心房颤动(AF)的患者发生缺血性卒中和死亡率的风险较高。然而,利伐沙班与AMI和新发AF患者预后之间的关系仍不确定。本研究补充:在接受双重抗血小板治疗的AMI和新发房颤患者中,利伐沙班使用者和非口服抗凝剂使用者在卒中、缺血性卒中、出血性卒中、全因死亡率、心血管死亡率、出血或大出血的风险方面没有显著差异。然而,由于本研究样本量小,统计能力有限,这些结果应谨慎解释。该研究对研究、实践或政策的影响:需要未来的前瞻性大规模研究和随机对照试验来进一步研究利伐沙班和其他类型的口服抗凝剂在AMI和新发AF患者中的作用。
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
Postgraduate Medical Journal
Postgraduate Medical Journal 医学-医学:内科
CiteScore
8.50
自引率
2.00%
发文量
131
审稿时长
2.5 months
期刊介绍: Postgraduate Medical Journal is a peer reviewed journal published on behalf of the Fellowship of Postgraduate Medicine. The journal aims to support junior doctors and their teachers and contribute to the continuing professional development of all doctors by publishing papers on a wide range of topics relevant to the practicing clinician and teacher. Papers published in PMJ include those that focus on core competencies; that describe current practice and new developments in all branches of medicine; that describe relevance and impact of translational research on clinical practice; that provide background relevant to examinations; and papers on medical education and medical education research. PMJ supports CPD by providing the opportunity for doctors to publish many types of articles including original clinical research; reviews; quality improvement reports; editorials, and correspondence on clinical matters.
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