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Original Research: Cardiovascular Disease |

Incidence of Myocardial Infarction and Vascular Death in Elderly Patients With Atrial Fibrillation Taking AnticoagulantsAtrial Fibrillation and Myocardial Infarction: Relation to Atherosclerotic Risk Factors

Daniele Pastori, MD; Pasquale Pignatelli, MD; Francesco Angelico, MD; Alessio Farcomeni, PhD; Maria Del Ben, MD; Tommasa Vicario, MD; Tommaso Bucci, MD; Valeria Raparelli, MD; Roberto Cangemi, MD; Gaetano Tanzilli, MD; Gregory Y. H. Lip, MD; Francesco Violi, MD
Author and Funding Information

From I Clinica Medica, the Department of Internal Medicine and Medical Specialties (Drs Pastori, Pignatelli, Del Ben, Vicario, Bucci, Raparelli, Cangemi, and Violi), the Department of Science of Public Health and Infectious Diseases (Drs Angelico and Farcomeni), and the Department of the Heart and Great Vessels Attilio Reale (Dr Tanzilli), Sapienza University of Rome, Rome, Italy; and University of Birmingham Centre for Cardiovascular Sciences (Prof Lip), City Hospital, Birmingham, England.

CORRESPONDENCE TO: Francesco Violi, MD, I Clinica Medica, Viale del Policlinico 155, Rome, 00161, Italy; e-mail: francesco.violi@uniroma1.it


Prof Lip and Dr Violi are the joint senior authors of this article. Drs Pastori and Pignatelli contributed equally to this article.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1644-1650. doi:10.1378/chest.14-2414
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BACKGROUND:  Recent findings suggest that patients with atrial fibrillation (AF), in addition being at thromboembolic risk, are at risk of myocardial infarction (MI). Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants.

METHODS:  We prospectively followed up 1,019 patients with AF for a median of 33.7 months (3,223 person-years). All patients were treated with oral vitamin K antagonists. Primary outcome was a composite end point of cardiovascular events (CVEs) including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death.

RESULTS:  The mean age of the patients was 73.2 years, and 43.8% were women. At follow-up, 111 CVEs (3.43%/y) had occurred: 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths. In addition, 31 stroke/transient ischemic attacks (0.96%/y) were recorded. Patients experiencing CVEs were older (P < .001) and had a higher prevalence of metabolic syndrome (MetS) (P = .005), heart failure (P = .001), and prior cardiac (P < .001) and cerebrovascular events (P < .001). On a Cox proportional hazard analysis, age (hazard ratio [HR], 1.083; 95% CI, 1.053-1.113; P < .001), smoking (HR, 2.158; 95% CI, 1.193-3.901; P = .011), history of cerebrovascular (HR, 1.704; 95% CI, 1.119-2.597; P = .013) and cardiac (HR, 1.658; 95% CI, 1.105-2.489; P = .015) events, MetS (HR, 1.663; 95% CI, 1.107-2.499; P = .014), heart failure (HR, 1.584; 95% CI, 1.021-2.456; P = .040), and male sex (HR, 1.499; 95% CI, 1.010-2.223; P = .044) predicted CVEs.

CONCLUSIONS:  Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment. MetS is a common clinical feature in patients with AF, which increases the risk of CVEs. A holistic approach is needed to reduce the cardiovascular risk in patients with AF.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01882114; URL: www.clinicaltrials.gov


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