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Cancer‐specific ischemic complications in elderly patients with atrial fibrillation: Data from the prospective ATHERO‐AF study
Author(s) -
Pastori Daniele,
Menichelli Danilo,
Bucci Tommaso,
Violi Francesco,
Pignatelli Pasquale
Publication year - 2020
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.33179
Subject(s) - medicine , hazard ratio , atrial fibrillation , mace , prospective cohort study , myocardial infarction , cancer , stroke (engine) , proportional hazards model , cardiology , lung cancer , confidence interval , percutaneous coronary intervention , mechanical engineering , engineering
Cancer may complicate the clinical course of nonvalvular atrial fibrillation (AF) but its association with cardiovascular events (CVEs) remains unclear. We performed a prospective cohort study including 2092 consecutive AF patients on vitamin K antagonists. Principal endpoint was the occurrence of CVEs including fatal/nonfatal myocardial infarction and ischemic stroke/transient ischemic attack and cardiovascular death. Secondary endpoints were major adverse cardiac events (MACEs) and thromboembolism (TE). Mean age was 73.7 ± 9.1 years and 42.1% were women; 367 (17.5%) patients had cancer: 21% gastrointestinal (GI), 10% respiratory, 28% genitourinary and 41% had other localization. Cancer patients were older but with similar comorbidities than those without. During a mean of 35.9 months, 203 CVEs occurred (incidence rate [IR] = 3.24 per 100 patient‐years): 133 MACEs (IR = 2.12 per 100 patient‐years) and 70 TE (IR = 1.12 per 100 patient‐years). Multivariable Cox proportional hazards regression analysis showed an association between GI cancer and MACE occurrence (hazard ratio [HR] = 3.22, 95% confidence interval [CI] = 1.59‐6.52, P = .001) and between respiratory cancer and TE (HR = 3.37, 95% CI = 1.30‐8.75, P = .013). These associations were confirmed at competing risk analysis. In conclusion, AF patients with cancer have specific vascular outcomes according to cancer site, as indicated by the higher risk of MACE and TE in patients with gastrointestinal and respiratory cancer, respectively.