Risk of Stroke or Systemic Embolism According to Baseline Frequency and Duration of Subclinical Atrial Fibrillation: Insights From the ARTESiA Trial

作者：William F. McIntyre, Alexander P. Benz, Jeff S. Healey, Stuart J. Connolly, Mu Yang, Shun Fu Lee, Thalia S. Field, Marco Alings, Juan Benezet‐Mazuecos, Giuseppe Boriani, Jens Cosedis Nielsen, Michael R. Gold, Francesco Pergolini, Taya V. Glotzer, Christopher B. Granger, Renato D. Lópes · 发表于：Circulation · 年份：2024 · DOI：10.1161/circulationaha.124.069903 · 被引用次数：25 · 研究领域：Atrial Fibrillation Management and Outcomes、Venous Thromboembolism Diagnosis and Management、Acute Ischemic Stroke Management

BACKGROUND: In the ARTESiA trial (Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation), apixaban, compared with aspirin, reduced stroke or systemic embolism in patients with device-detected subclinical atrial fibrillation (SCAF). Clinical guidelines recommend considering SCAF episode duration when deciding whether to prescribe oral anticoagulation for this population. METHODS: We performed a retrospective cohort study in ARTESiA. Using Cox regression adjusted for CHA 2 DS 2 -VASc score and treatment allocation (apixaban or aspirin), we assessed frequency of SCAF episodes and duration of the longest SCAF episode in the 6 months before randomization as predictors of stroke risk and of apixaban treatment effect. RESULTS: Among 3986 patients with complete baseline SCAF data, 703 (17.6%) had no SCAF episode ≥6 minutes in the 6 months before enrollment. Among 3283 patients (82.4%) with ≥1 episode of SCAF ≥6 minutes in the 6 months before enrollment, 2542 (77.4%) had up to 5 episodes, and 741 (22.6%) had ≥6 episodes. The longest episode lasted <1 hour in 1030 patients (31.4%), 1 to <6 hours in 1421 patients (43.3%), and >6 hours in 832 patients (25.3%). Higher baseline SCAF frequency was not associated with increased risk of stroke or systemic embolism: 1.1% for 1 to 5 episodes versus 1.2%/patient-year for ≥6 episodes (adjusted hazard ratio, 0.89 [95% CI, 0.59–1.34]). In an exploratory analysis, patients with previo...