Abstract The 2MACE score was specifically developed as a risk-stratification tool in atrial fibrillation (AF) to predict cardiovascular outcomes. We evaluated the predictive ability of the 2MACE score in the GLORIA-AF registry. All eligible patients from phase II/III of the prospective global GLORIA-AF registry were included. Major adverse cardiac events (MACEs) were defined as the composite outcome of stroke, myocardial infarction and cardiovascular death. Cox proportional hazards were used to examine the relationship between the 2MACE score and study outcomes. Predictive capability of the 2MACE score was investigated using receiver-operating characteristic curves. A total of 25,696 patients were included (mean age 71 years, female 44.9%). Over 3 years, 1583 MACEs were recorded. Patients who had MACE were older, with more cardiovascular risk factors and were less likely to be managed using a rhythm-control strategy. The median 2MACE score in the MACE and non-MACE groups were 2 (IQR 1–3) and 1 (IQR 0–2), respectively (p < 0.001). The 2MACE score was positively associated with an increase in the risk of MACE, with a score of ≥ 2 providing the best combination of sensitivity (69.6%) and specificity (51.6%), HR 2.47 (95% CI, 2.21–2.77). The 2MACE score had modest predictive performance for MACE in patients with AF (AUC 0.655 (95% CI, 0.641–0.669)). Our analysis in this prospective global registry demonstrates that the 2MACE score can adequately predict the risk of MACE (defined as myocardial infarction, CV death and stroke) in patients with AF. Clinical trial registration: http://www.clinicaltrials.gov . Unique identifiers: NCT01468701, NCT01671007 and NCT01937377
Drug eluting stents for the treatment of small vessel coronary artery disease have traditionally yielded inferior clinical outcomes compared to the use of DES in large vessels. The benefit of the second-generation Resolute zotarolimus-eluting stent (R-ZES) in small vessels was examined.Two-year clinical outcomes from five combined R-ZES studies were compared between patients with small (reference vessel diameter [RVD] ≤2.5 mm; n = 1,956) and large (RVD >2.5 mm; n = 3174) vessels.Despite a higher incidence of comorbidities in the small vessel group, there was no significant difference in target lesion failure (TLF) (10.1% vs. 8.7%; P = 0.54) at 2 years. When the subgroup of patients with diabetes was examined (n = 1,553) there was no significant difference in 2-year TLF in small compared to large vessels (11.2% vs. 11.1%; P = 0.17). Similarly, within the small vessel cohort, no significant difference was seen regarding TLF at 2 years between people with and without diabetes (11.2% vs 9.6%; P = 0.28).When used for the treatment of small vessels, the R-ZES appears to provide acceptable clinical results at 2 years when compared to its performance in large vessels.
Abstract Aims Chronic Obstructive Pulmonary Disease (COPD) may influence management and prognosis of Atrial Fibrillation (AF), but this relationship has been scarcely explored in contemporary global cohorts. We aimed to investigate the association between AF and COPD, in relation to treatment patterns and major outcomes. Methods From the prospective, global GLORIA-AF Registry, we analysed factors associated with COPD diagnosis, as well as treatment patterns and risk of major outcomes in relation to COPD. Primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Results 36,263 patients (mean age 70.1±10.5 years, 45.2% females) were included; 2,261 (6.2%) had COPD. Prevalence of COPD was lower in Asia, and higher in North America. Age, female sex, smoking, BMI, and cardiovascular comorbidities were associated with presence of COPD. COPD was associated with higher use of OAC (adjusted Odds Ratio [aOR] and 95% Confidence Interval [CI]: 1.29 [1.13-1.47]), and higher OAC discontinuation (adjusted Hazard Ratio [aHR] and 95%CI: 1.12 [1.01-1.25]). COPD was associated with less use of beta-blocker (aOR [95%CI]: 0.79 [0.72-0.87]), amiodarone and propafenone, and higher use of digoxin and verapamil/diltiazem. Patients with COPD had higher hazard of primary composite outcome (aHR [95%CI]: 1.78 [1.58-2.00]); no interaction was observed regarding beta-blocker use. COPD was also associated with all-cause death (aHR [95%CI]: 2.01 [1.77-2.28]), MACEs (aHR [95%CI]: 1.41 [1.18-1.68]) and major bleeding (aHR [95%CI]: 1.48 [1.16-1.88]). Conclusions In AF patients, COPD was associated with differences in OAC treatment and use of drugs. AF/COPD patients had worse outcomes, including higher mortality, MACE and major bleeding.
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