Cancer‐specific ischemic complications in elderly patients with atrial fibrillation: Data from the prospective ATHERO‐AF study. Issue 12 (11th July 2020) - Pastori, Daniele
Abstract: Cancer may complicate the clinical course of nonvalvular atrial fibrillation (AF) but its association with cardiovascular events (CVEs) remains unclear. We performed a prospective cohort study including 2092 consecutive AF patients on vitamin K antagonists. Principal endpoint was the occurrence of CVEs including fatal/nonfatal myocardial infarction and ischemic stroke/transient ischemic attack and cardiovascular death. Secondary endpoints were major adverse cardiac events (MACEs) and thromboembolism (TE). Mean age was 73.7 ± 9.1 years and 42.1% were women; 367 (17.5%) patients had cancer: 21% gastrointestinal (GI), 10% respiratory, 28% genitourinary and 41% had other localization. Cancer patients were older but with similar comorbidities than those without. During a mean of 35.9 months, 203 CVEs occurred (incidence rate [IR] = 3.24 per 100 patient‐years): 133 MACEs (IR = 2.12 per 100 patient‐years) and 70 TE (IR = 1.12 per 100 patient‐years). Multivariable Cox proportional hazards regression analysis showed an association between GI cancer and MACE occurrence (hazard ratio [HR] = 3.22, 95% confidence interval [CI] = 1.59‐6.52, P = .001) and between respiratory cancer and TE (HR = 3.37, 95% CI = 1.30‐8.75, P = .013). These associations were confirmed at competing risk analysis. In conclusion, AF patients with cancer have specific vascular outcomes according to cancer site, as indicated by the higher risk of MACE and TE in patients with gastrointestinal and respiratory cancer, respectively. Abstract : What's new? While patients with atrial fibrillation (AF) are at increased risk of death from cardiovascular events (CVEs), a significant proportion die of cancer. Cancer and CVEs may be related, though little is known about cancer site and cardiovascular complications in AF. In this study involving more 2090 AF patients taking vitamin K anticoagulants, cancer was found to be a common comorbidity, affecting 17.5 percent of patients. In particular, gastrointestinal cancer was associated with increased risk of CVEs, while respiratory tract cancer was associated with an increased risk of thromboembolism. The findings link specific vascular outcomes with cancer site in AF.