Abstract 16572: Association of Atrial Fibrosis With Major Adverse Cardiac Events in Patients With Non-valvular Atrial Fibrillation
Background: Extensive of atrial fibrosis has been demonstrated to significantly predict success of catheter ablation. However, impact of extensive fibrosis on other aspects of patient care and long-term prognosis is unknown.
Methods: We conducted a historical cohort study to assess the hypothesis that increased degree of atrial fibrosis is independently associated with major adverse cardiac events (MACE). We reviewed 853 patients with non-valvular atrial fibrillation (NVAF) and quantified fibrosis. Logistic regression models were used to evaluate the association of percent fibrosis on experiencing a MACE. Linear splines were utilized to allow the functional form of the exposure to vary at high (>15%) and low (<15%) fibrosis scores. The outcome of interest was a composite of MACE: myocardial infarction (MI), ischemic stroke (IS), or venous thromboembolism (VTE).
Results: The mean age of the cohort was 66.2±12.4 with 66% male and 79% white. During a median follow-up of 2.9 years, 69 (8.1%), 46 (5.4%), 52 (6.1%), and 156 (18.3%) of patients experienced an MI, IS, VTE, or MACE, respectively. High fibrosis patients were more likely to be older, male, and have a higher CHA2DS2-VASc score. In the unadjusted analysis, increased fibrosis was associated with increased odds of a MI (OR [95% CI] P-Value: 1.30 [1.00, 1.68] 0.05) or any MACE (1.28 [1.06, 1.56] 0.01), but not with IS or VTE. After adjusting for potential confounders, increasing fibrosis levels had significantly increased odds of MI (1.53 [1.02, 2.28] 0.04) and VTE (1.52 [1.17, 2.86] <0.01) when fibrosis levels were above 15%. There was no significant association below 15%. The odds of a MACE was significant above 15% (1.64 [1.18, 2.27] <0.01) and across all fibrosis scores (1.23 [1.01, 1.49] 0.04), but was insignificant when only fibrosis levels below 15% were examined.
Conclusions: Advanced degree of atrial fibrosis in patients with NVAF is independently associated with increased risk of MI, VTE and a composite of MACE.
Author Disclosures: J.B. King: None. M. Singhal: None. G. Kaur: None. K. Johnson: None. C. Pacchia: None. J. Biskupiak: None. N. Marrouche: None.
- © 2015 by American Heart Association, Inc.