Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism
Behnood Bikdeli, David Jiménez, J. del Toro, Gregory Piazza, A. Rivas, José Luis Fernández‐Reyes, A. Sampériz, Remedios Otero, José María Suriñach, Carmine Siniscalchi, Javier Miguel Martín Guerra, Joaquín Castro, Alfonso Muriel, Gregory Y.H. Lip, Samuel Z. Goldhaber, Manuel Monréal, Manuel Monréal, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, Henri Bounameaux, Radován Malý, Peter Verhamme, Joseph A. Caprini, My Bui, María Dolores Adarraga, María Agud, Jesús Aibar, Miguel Ángel Aibar Arregui, Cristina Amado, Juan I. Arcelus, C. Baeza, Aitor Ballaz, Raquel Barba, Cristina Barbagelata, Manuel Barrón, B. Barrón‐Andrés, Ángeles Blanco‐Molina, Ernesto Botella, Ana María Camon, Inmaculada Cañas, I. Casado, Joaquín Castro, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel‐Díez, J. del Toro, Pablo Demelo‐Rodríguez, José Antonio Díaz‐Peromingo, M Campli, Javier Díez‐Sierra, Irene Milagros Domínguez, José Carlos Escribano, C. Falgá, Ana Isabel Farfán‐Sedano, Carmen Fernández‐Capitán, José Luis Fernández‐Reyes, María Ángeles Fidalgo, Katia Flores, Carme Font, Llorenç Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, David Javier Galindo, Maria A. García, F. García‐Bragado, Marta García de Herreros, R. García-Hernáez, María Mar García‐Mullor, Arantxa García‐Raso, Olga Gavín‐Sebastián, Aída Gil‐Díaz, Covadonga Gómez‐Cuervo, Enric Grau, Leticia Guirado, Javier Cuesta, Luis Blasco, Elena Hernando, Miguel Herreros, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, Rafael Jiménez, M.D. Joya, José Manuel Ramos León, Jorge Roberto Perrout de Lima, Pilar Llamas, José Luís Lobo, Luciano López‐Jiménez, P. López-Miguel, Juan J. López-Núñez
Abstract
Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.