TY - JOUR
T1 - Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up
AU - Xia, Yu
AU - Stern, David
AU - Friedmann, Patricia
AU - Goldstein, Daniel
N1 - Funding Information:
Data collection for this work was supported in whole or in part by the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN268201100025C. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) or the National Institutes of Health. This research was also supported in part by the National Institutes of Health/National Center for Advancing Translational Science Einstein-Montefiore Clinical and Translational Science Awards Grant No. UL1TR001073.
Publisher Copyright:
© 2016 International Society for Heart and Lung Transplantation
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background Atrial fibrillation (AF) is a well-established risk factor for thromboembolic (TE) complications. AF is frequently found in patients with advanced heart failure, including patients undergoing left ventricular assist device (LVAD) implantation. However, reports on whether preoperative AF increases the risk of TE events after LVAD implantation are scarce and limited to single-center or 2-center studies. We sought to evaluate the association of preoperative AF with TE events and patient survival using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Methods A retrospective analysis of INTERMACS data of primary continuous-flow LVADs implanted between May 2012 and December 2013 was performed. Adult patients were dichotomized as having AF or no AF (NAF). TE events were defined as cerebrovascular accident, transient ischemic attack, hemolysis, arterial non–central nervous system embolism, or explant because of pump thrombosis. Kaplan-Meier analysis and multivariate Cox regression were performed for freedom from TE and patient survival. Results Of 3,909 patients identified during the study period, 838 (21.4%) had preoperative AF. Patients with AF were older, were likely to be male, and had more comorbidities (p < 0.01). In the AF group, 236 TE events occurred in 175 (20.9%) patients. In the NAF group, 900 TE events occurred in 691 (22.5%) patients. The TE event rate was not significantly different between the 2 groups (0.36 events/patient-year in AF group vs 0.37 events/patient-year in NAF group, p = 0.60). On univariate analysis, AF was not significantly associated with freedom from TE but was associated with decreased patient survival (log-rank test p = 0.03). On multivariate analysis, AF was not significantly associated with either TE (adjusted hazard ratio 0.95; 95% confidence interval, 0.80–1.13) or patient survival (adjusted hazard ratio 1.09; 95% confidence interval, 0.91–1.31). Conclusions Analysis of INTERMACS suggests that preoperative AF may not increase the risk of postoperative TE complications or patient mortality on midterm follow-up. Longer follow-up to confirm these findings is warranted.
AB - Background Atrial fibrillation (AF) is a well-established risk factor for thromboembolic (TE) complications. AF is frequently found in patients with advanced heart failure, including patients undergoing left ventricular assist device (LVAD) implantation. However, reports on whether preoperative AF increases the risk of TE events after LVAD implantation are scarce and limited to single-center or 2-center studies. We sought to evaluate the association of preoperative AF with TE events and patient survival using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Methods A retrospective analysis of INTERMACS data of primary continuous-flow LVADs implanted between May 2012 and December 2013 was performed. Adult patients were dichotomized as having AF or no AF (NAF). TE events were defined as cerebrovascular accident, transient ischemic attack, hemolysis, arterial non–central nervous system embolism, or explant because of pump thrombosis. Kaplan-Meier analysis and multivariate Cox regression were performed for freedom from TE and patient survival. Results Of 3,909 patients identified during the study period, 838 (21.4%) had preoperative AF. Patients with AF were older, were likely to be male, and had more comorbidities (p < 0.01). In the AF group, 236 TE events occurred in 175 (20.9%) patients. In the NAF group, 900 TE events occurred in 691 (22.5%) patients. The TE event rate was not significantly different between the 2 groups (0.36 events/patient-year in AF group vs 0.37 events/patient-year in NAF group, p = 0.60). On univariate analysis, AF was not significantly associated with freedom from TE but was associated with decreased patient survival (log-rank test p = 0.03). On multivariate analysis, AF was not significantly associated with either TE (adjusted hazard ratio 0.95; 95% confidence interval, 0.80–1.13) or patient survival (adjusted hazard ratio 1.09; 95% confidence interval, 0.91–1.31). Conclusions Analysis of INTERMACS suggests that preoperative AF may not increase the risk of postoperative TE complications or patient mortality on midterm follow-up. Longer follow-up to confirm these findings is warranted.
KW - INTERMACS
KW - LVAD
KW - atrial fibrillation
KW - patient survival
KW - thromboembolic events
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U2 - 10.1016/j.healun.2016.03.003
DO - 10.1016/j.healun.2016.03.003
M3 - Article
C2 - 27132796
AN - SCOPUS:84964597331
SN - 1053-2498
VL - 35
SP - 906
EP - 912
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 7
ER -