Incidence of Myocardial Infarction and Vascular Death in Elderly Patients With Atrial Fibrillation Taking Anticoagulants Relation to Atherosclerotic Risk Factors

BACKGROUND: Recent findings suggest that patients with atrial fibrillation (AF), in addition to thromboembolic risk, are also at risk for myocardial infarction (MI). Our aim was to investigate predictors of MI and cardiovascular death in a cohort of anticoagulated AF patients. METHODS: We prospectively followed-up 1019 AF patients for a median of 33.7 months (3223 person/years). All patients were treated with oral vitamin K antagonists. Primary outcome was a composite endpoint of cardiovascular events (CVEs) including fatal/non-fatal MI, cardiac revascularization and cardiovascular death. RESULTS: Mean age was 73.2 years, 43.8% were female. At follow-up, 111 CVEs (3,43%/year) occurred: 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths. In addition, 31 stroke/TIA (0.96%/year) were recorded. Patients experiencing CVEs were older (p<0.001), with a higher prevalence of metabolic syndrome (MetS, p=0.005), heart failure (HF, p=0.001), prior cardiac (p<0.001) and cerebrovascular events (p<0.001). On a Cox proportional hazard analysis, age (hazard ratio [HR] 1.083, 95% confidence interval [CI], 1.053-1.113, p<0.001), smoking (HR 2.158, 95% CI, 1.193-3.901, p=0.011), history of cerebrovascular (HR 1.704, 95% CI, 1.119-2.597, p=0.013), and cardiac events (HR 1.658, 95% CI, 1.105-2.489, p=0.015), MetS (HR 1.663, 95% CI, 1.107-2.499, p=0.014), HF (HR 1.584, 95% CI, 1.021-2.456, p=0.040), male sex (HR 1.499, 95% CI, 1.010-2.223, p=0.044) predicted CVEs. CONCLUSIONS: AF patients still experience a high rate of CVEs despite being on anticoagulant treatment. MetS is a common clinical feature in AF patients, which increases the risk of CVEs. A holistic approach is needed to reduce the risk of cardiovascular risk in patients with AF. Clinical Trial Registration: ClinicalTrials.gov NCT01882114.