Open AccessPrognostic Significance of Premature Atrial Complexes Burden in Prediction of Long‐Term Outcome
Author(s) -
Lin ChinYu,
Lin YennJiang,
Chen YunYu,
Chang ShihLin,
Lo LiWei,
Chao TzeFan,
Chung FaPo,
Hu YuFeng,
Chong Eric,
Cheng HaoMin,
Tuan TaChuan,
Liao JoNan,
Chiou ChuenWang,
Huang JinLong,
Chen ShihAnn
Publication year - 2015
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.002192
Subject(s) - medicine , hazard ratio , atrial fibrillation , heart failure , cardiology , myocardial infarction , confidence interval , proportional hazards model , premature atrial contraction , sinus rhythm , sick sinus syndrome , multivariate analysis
Background The prognostic significance of premature atrial complex ( PAC ) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PAC s and long‐term outcome. Methods and Results We investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation ( AF ) or a permanent pacemaker ( PPM ) at baseline who underwent 24‐hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow‐up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular‐related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new‐onset AF , and 132 PPM implantations. The optimal cut‐off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI : 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI : 1.137 to 1.451), new‐onset AF (hazard ratio: 1.757, 95% CI : 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI : 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PAC s increased risk of PPM implantation owing to sick sinus syndrome, high‐degree atrioventricular block, and/or AF . Conclusions The burden of PAC s is independently associated with mortality, cardiovascular hospitalization, new‐onset AF , and PPM implantation in the long term.