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Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

2021; Wiley; Volume: 10; Issue: 17 Linguagem: Inglês

10.1161/jaha.121.021467

2047-9980

Behnood Bikdeli, David Jiménez, J. del Toro, Gregory Piazza, A. Rivas, José Luis Fernández‐Reyes, A. Sampériz, Remedios Otero, José María Suriñach, Carmine Siniscalchi, Javier Miguel Martín Guerra, Joaquín Castro, Alfonso Muriel, Gregory Y.H. Lip, Samuel Z. Goldhaber, Manuel Monréal, Manuel Monréal, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, Henri Bounameaux, Radován Malý, Peter Verhamme, Joseph A. Caprini, My Bui, María Dolores Adarraga, María Agud, Jesús Aibar, Miguel Ángel Aibar Arregui, Cristina Amado, Juan I. Arcelus, C. Baeza, Aitor Ballaz, Raquel Barba, Cristina Barbagelata, Manuel Barrón, B. Barrón‐Andrés, Ángeles Blanco‐Molina, Ernesto Botella, Ana María Camon, Inmaculada Cañas, I. Casado, Joaquín Castro, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel‐Díez, J. del Toro, Pablo Demelo‐Rodríguez, José Antonio Díaz‐Peromingo, M Campli, J. Díez-Sierra, Irene Milagros Domínguez, José Carlos Escribano, C. Falgá, Ana Isabel Farfán‐Sedano, Carmen Fernández‐Capitán, José Luis Fernández‐Reyes, María Ángeles Fidalgo, Katia Flores, Carme Font, Carme Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, David Javier Galindo, Maria A. García, F. García‐Bragado, Marta García de Herreros, R. García-Hernáez, María Mar García‐Mullor, Aránzazu García‐Raso, Olga Gavín‐Sebastián, A. Gil-Díaz, Covadonga Gómez‐Cuervo, Enric Grau, Leticia Guirado, Javier Cuesta, Luis Blasco, M. Elena Hernando, Miguel Herreros, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, Rafael Jiménez, M.D. Joya, José Manuel Ramos León, Jorge Roberto Perrout de Lima, Pilar Llamas, José Luís Lobo, Luciano López‐Jiménez, P. López-Miguel, Juan J. López-Núñez, Raquel López‐Reyes, Antonio López‐Ruiz, J.B. López‐Sáez, Alicia Lorenzo, Olga Madridano, Ana M. Maestre, Pablo Javier Marchena, M. Martín del Pozo, Javier Miguel Martín Guerra, F. Martín‐Martos, C Mella, Meritxell Mellado, Maria Isabel Mercado, Jorge Moisés, Manuel Monréal, María del Valle Morales, Arturo Muñoz Blanco, A. Rivas, María Sierra Navas, José Antonio Nieto, Manuel Jesús Núñez‐Fernández, Berta Obispo, M. Olid, María Carmen Olivares, José Luis Orcastegui, Clara Ortega‐Michel, Jeisson Osorio, S. Otálora, Remedios Otero, Pedro Parra, Virginia Parra, José María Pedrajas, G. Pellejero, José Antonio Porras, José Portillo, Antoni Riera‐Mestre, A. Rivas, F. Rivera-Cívico, Diego Agustín Rodríguez‐Chiaradía, A. Rodríguez-Cobo, Consolación Rodríguez-Matute, Jacobo Rogado, Sonia Roig Gómez, Vladimir Rosa, Pedro Ruiz‐Artacho, N. Ruiz‐Giménez, Justo Ruiz-Ruiz, Pablo Ruiz Sada, Giorgina Salgueiro, Rosario Sánchez‐Martínez, J.F. Sánchez‐Muñoz‐Torrero, Teresa Sancho, Merçe Sirisi, Silvia Soler, José María Suriñach, Raimundo Tirado, Marı́a Isabel Torres, Carles Tolosa, Javier Trujillo‐Santos, Fernando Uresandi, B. Valero, Reina Valle, J. Vela, G. Vidal, Paula Villares, Carles Zamora, Paula Gutiérrez, Fernando Javier Vázquez, Matthias M. Engelen, Thomas Vanassche, Peter Verhamme, Jana Hirmerová, Radován Malý, E. Salgado, Nassim Ait Abdallah, Laurent Bertoletti, A. Bura-Rivière, Benjamin Crichi, Philippe Debourdeau, Espitia Olivier, Nicolas Falvo, Dominique Farge, Silvia Galliazzo, H. L. Helfer, Isabelle Mahé, Farès Moustafa, Géraldine Poenou, Sebastian Schellong, Andrei Braester, Benjamin Brenner, Inna Tzoran, Franca Bilora, Eugenio Bucherini, Maurizio Ciammaichella, Pierpaolo Di Micco, Egidio Imbalzano, R. Maida, Daniela Mastroiacovo, F. Pace, Raffaele Pesavento, Fulvio Pomero, Paolo Prandoni, Roberto Quintavalla, Anna Rocci, Roberta Romualdi, Carmine Siniscalchi, Antonella Tufano, Adriana Visonà, Beniamino Zalunardo, Valdis Ģībietis, Dana Kigitoviča, Andris Skride, Samuel Ferreira da Fonseca, Filipa Martins, J. Meireles, Marijan Bosevski, Henri Bounameaux, Lucia Mazzolai, Behnood Bikdeli, Joseph A. Caprini, Alfonso Tafur, Cassius Iyad Ochoa‐Chaar, Ido Weinberg, Hannah Wilkins, My Bui,

Acute Ischemic Stroke Management

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.