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Circulation: Arrhythmia and Electrophysiology
Paroxysmal atrial fibrillation was associated with lower stroke and mortality than persistent and permanent atrial fibrillation in this substudy examining atrial fibrillation patterns from the large, multicenter ENGAGE AF TIMI 48 randomized trial of edoxaban compared with warfarin. Similar to the primary trial results, edoxaban was noninferior to warfarin across each of the patterns of atrial fibrillation.
Stroke and Mortality Risk in Patients With Various Patterns of Atrial Fibrillation
Results From the ENGAGE AF-TIMI 48 Trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48)
Mark S. Link, MD, Robert P. Giugliano, MD, SM, Christian T. Ruff, MD, MPH, Benjamin M. Scirica, MD, MPH, Heikke Huikuri, MD, Ali Oto, MD, Andrea E.Crompton, RN, BSN, Sabina A. Murphy, MPH, Hans Lanz, MD, Michele F. Mercuri, MD, Elliott M. Antman, MD, Eugene Braunwald, MD on behalf of the ENGAGE AF-TIMI 48 Investigators
Correspondence to: Mark S. Link, MD, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390. E-mail firstname.lastname@example.org
BACKGROUND: Whether the pattern of atrial fibrillation (AF) modifies the risk/benefit of anticoagulation is controversial. In ENGAGE AF-TIMI 48 trial (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48), the factor Xa inhibitor edoxaban was noninferior to warfarin in preventing stroke or systemic embolic events and significantly reduced bleeding and cardiovascular mortality. However, detailed analyses by AF pattern have not been reported.
METHODS AND RESULTS: The 21 105 patients were categorized as having paroxysmal (<7 days duration), persistent (≥7 days but <1 year), or permanent (≥1 year or failed cardioversion) AF patterns at randomization. Efficacy and safety outcomes were evaluated during the 2.8 years median follow-up and compared by AF pattern. The primary end point of stroke/systemic embolic event was lower in those patients with paroxysmal AF (1.49%/year), compared with persistent (1.83%/year; P-adj=0.015) and permanent AF (1.95%/year; P-adj=0.004). Overall, all-cause mortality also was lower with paroxysmal (3.0%/year) compared with persistent (4.4%/yr; P-adj <0.001) and permanent AF (4.4%/year; P-adj <0.001). Annualized major bleeding …