Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study

Giuseppe Mule', Antonina Giammanco, Antonino Tuttolomondo, Domenico Di Raimondo, Maurizio Averna, Giovanni Cerasola, Mario Barbagallo, Alessandro Scordo, Francesco Antonio Salzano, Giovam Battista Rini, Salvatore Corrao, Andrea Fattorini, Carmelo Butta', Daniele Torres, Francesco Paolo Sposito, Giuseppe Melis, Maria Rosaria Cangemi, Mario Sprovieri, Mauro Anzaldi, Natale Sergio GloriosoVincenzo Zaccone

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Chronic obstructive pulmonary disease (COPD) increases the risk of mortality in non-valvular atrial fibrillation (NVAF) patients. Data on the relationship of COPD to major cardiovascular events (MACE) in AF have not been defined. The aim of the study is to assess the predictive value of COPD on incident MACE in NVAF patients over a 3-year follow-up. In the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study (ARAPACIS) cohort, we evaluate the impact of COPD on the following clinical endpoints: MACE (including vascular death, fatal/non-fatal MI and stroke/TIA), cardiovascular (CV) death and all-cause mortality. Among 2027 NVAF patients, patients with COPD (9%) are more commonly male, elderly and at higher thromboembolic risk. During a median 36.0 months follow-up, 186 patients experienced MACE: vascular death (n = 72), MI (n = 57), stroke/TIA (n = 57). All major outcomes (including stroke/TIA, MI, vascular death, and all-cause death) are centrally adjudicated. Kaplan–Meier curves show that NVAF patients with COPD are at higher risk for MACE (p < 0.001), CV death (p < 0.001) and all-cause death (p < 0.001). On Cox proportional hazard analysis, COPD is an independent predictor of MACE (Hazard ratio [HR] 1.77, 95% Confidence Intervals [CI] 1.20–2.61; p = 0.004), CV death (HR 2.73, 95% CI 1.76–4.23; p < 0.0001) and all-cause death (HR 2.16, 95% CI 1.48–3.16; p < 0.0001). COPD is an independent predictor of MACE, CV death and all-cause death during a long-term follow-up of NVAF patients.
Original languageEnglish
Pages (from-to)651-660
Number of pages10
JournalInternal and Emergency Medicine
Volume13
Publication statusPublished - 2018

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Emergency Medicine

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