Clinical research studyCoronary Ischemic Events after First Atrial Fibrillation: Risk and Survival
Section snippets
Study Setting
The community-based cohort study was approved by the Mayo Foundation Institutional Review Board. Olmsted County, Minnesota, is well suited for the conduct of studies with long-term follow-up because of a number of unique features.12 Geographically, the community is relatively isolated from other urban centers, and medical care is delivered by only a few health care providers, principally the Mayo Clinic and its associated hospitals. The majority of Olmsted County residents return to the Mayo
Results
A total of 4618 subjects (51% were men; mean age 73 years) were confirmed to have developed a first AF during 1980 to 2000. We excluded 1776 subjects (38%) because they had a history of coronary heart disease and 74 subjects (2%) because they had a coronary ischemic event that occurred on the same day as the first AF. The remaining 2768 subjects (48% were men, mean age 71 years, range 18-107 years) constituted the study population. Of these, 463 patients (17%) had a total of 841 coronary
Discussion
In our community-based cohort, the first AF marks a high risk for new coronary ischemic events in both men and women. In contrast with men, AF conferred an additional risk of ischemic events in women beyond conventional risk prediction. The excess mortality risk associated with the development of new coronary ischemic events was greater in women.
Limitations
There were inherent biases associated with the retrospective design. It is possible that the incidence of AF may have been underestimated, given that some patients may not have received care at the Mayo Clinic, although the underestimation would likely be small because the Mayo Clinic is the principal health care provider and referral center for Olmsted County.12 Also, we may have underestimated the coronary event rates because we did not include those who had presumed angina but did not have
Conclusions
Patients diagnosed with a first AF constitute a high-risk group for subsequent new coronary ischemic events. Although the age-adjusted incidence of such post-AF coronary ischemic events was higher in men, AF actually conferred an additional risk for the development of ischemic events, beyond conventional risk prediction, in women only. Further, the excess mortality risk associated with the development of post-AF new coronary events was greater in women.
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Cited by (0)
This study was supported by the American Heart Association National Scientist Development Grant. There is no financial conflict on the part of any author.