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
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.
Summary Optimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600 mg loading dose (LD) of clopidogrel. We performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50 ± 23% with a large inter-individual variability (range: 1–94%). Patients with a VASP index ≥50% were significantly older (p= 0.03), with a higher body mass index (BMI) (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an acute coronary syndrome (ACS) and with a high fibrinogen level compared to good responders (VASP <50%). In multivariate analysis BMI, omeprazole use, ACS and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 –3.5; p=0.003). In conclusion, STEMI is associated with high on-treatment platelet reactivity following 600 mg of clopidogrel. The present results suggest that 600 mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred.
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