Cancer-specific ischemic complications in elderly Patients with atrial fibrillation. data from the prospective ATHERO-AF study

Cancer may complicate the clinical course of non-valvular atrial fibrillation (AF) but its association with cardiovascular events (CVEs) is still 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/non-fatal myocardial infarction (MI) and ischemic stroke/TIA and cardiovascular death. Secondary endpoints were major adverse cardiac events (MACE) and thromboembolism (TE). Mean age was 73.7 ± 9.1 years and 42.1% were women; 367 (17.5%) patients had cancer: 21% gastrointestinal, 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 MACE (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 gastrointestinal cancer and MACE occurrence (HR 3.22, 95%CI 1.59-6.52, P = 0.001) and between respiratory cancer and TE (HR 3.37, 95%CI 1.30-8.75, P = 0.013). These association 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 gut and lung cancer, respectively. This article is protected by copyright. All rights reserved.