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1. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Author

Fauchier, Grégoire, Bisson, Arnaud, Bodin, Alexandre, Herbert, Julien, Semaan, Carl, Angoulvant, Denis, Ducluzeau, Pierre Henri, Lip, Gregory, Fauchier, Laurent, Deharo, Pierre, Cuisset, Thomas, Lacour, Thibaud, Etienne, Christophe Saint, Jaussaud, Nicolas, Morera, Pierre, Spychaj, Jean-Charles, Porto, Alizée, Collart, Frederic, Theron, Alexis, Bernard, Anne, Bourguignon, Thierry, Simard, Trevor, Jung, Richard, Lehenbauer, Kyle, Piayda, Kerstin, Pracoń, Radoslaw, Jackson, Gregory, Flores-Umanzor, Eduardo, Faroux, Laurent, Korsholm, Kasper, Chun, Julian K.R., Chen, Shaojie, Maarse, Moniek, Montrella, Kristi, Chaker, Zakeih, Spoon, Jocelyn, Pastormerlo, Luigi, Meincke, Felix, Sawant, Abhishek, Moldovan, Carmen, Qintar, Mohammed, Aktas, Mehmet, Branca, Luca, Radinovic, Andrea, Ram, Pradhum, El-Zein, Rayan, Flautt, Thomas, Ding, Wern Yew, Sayegh, Bassel, Benito-González, Tomás, Lee, Oh-Hyun, Badejoko, Solomon, Paitazoglou, Christina, Karim, Nabeela, Zaghloul, Ahmed, Agrawal, Himanshu, Kaplan, Rachel, Alli, Oluseun, Ahmed, Aamir, Suradi, Hussam, Knight, Bradley, Alla, Venkata, Panaich, Sidakpal, Wong, Tom, Bergmann, Martin, Chothia, Rashaad, Kim, Jung-Sun, Pérez de Prado, Armando, Bazaz, Raveen, Gupta, Dhiraj, Valderrabano, Miguel, Sanchez, Carlos, El Chami, Mikhael, Mazzone, Patrizio, Adamo, Marianna, Ling, Fred, Wang, Dee Dee, O’neill, William, Wojakowski, Wojtek, Pershad, Ashish, Berti, Sergio, Spoon, Daniel, Kawsara, Akram, Jabbour, George, Boersma, Lucas V.A., Schmidt, Boris, Nielsen-Kudsk, Jens Erik, Rodés-Cabau, Josep, Freixa, Xavier, Ellis, Christopher, Demkow, Marcin, Sievert, Horst, Main, Michael, Hibbert, Benjamin, Holmes, David, Alkhouli, Mohamad, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Trousseau [Tours], Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), University of Liverpool, Aalborg University [Denmark] (AAU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Timone [CHU - APHM] (TIMONE), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Marseille, Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Institut de neurophysiopathologie (INP), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), University of Ottawa [Ottawa], Université Laval [Québec] (ULaval), National Institute for Research and Development in Microtechnologies (IMT-Bucharest), Graduate School, Cardiology, and ACS - Heart failure & arrhythmias

Subjects
Male, Cardiac Catheterization, Time Factors, Percutaneous, left atrial appendage occlusion, Septal Occluder Device, medicine.medical_treatment, Transesophageal, [SHS]Humanities and Social Sciences, Pulmonary vein, Postoperative Complications, Risk Factors, Interquartile range, Atrial Fibrillation, Registries, Embolization, ComputingMilieux_MISCELLANEOUS, Watchman, Incidence, Atrial fibrillation, Europe, Survival Rate, Treatment Outcome, Echocardiography, Cardiology, Female, Watchman FLX, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Heart Diseases, ACP, Amplatzer cardiac plug, Amulet, DRT, LAAO, device-related thrombus, Aged, Atrial Appendage, Echocardiography, Transesophageal, Follow-Up Studies, Humans, Thrombosis, Left atrial appendage occlusion, Internal medicine, medicine, Risk factor, Thrombus, business.industry, medicine.disease, business
Abstract

Background: Device-related thrombus (DRT) has been considered an Achilles’ heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.

Published
2021

2. Mortality and cardiac resynchronization therapy with or without defibrillation in primary prevention

Author

Deharo, Pierre, Bisson, Arnaud, Herbert, Julien, Lacour, Thibaud, Saint Etienne, Christophe, Jaussaud, Nicolas, Theron, Alexis, Collart, Frederic, Bourguignon, Thierry, Cuisset, Thomas, Fauchier, Laurent, Gras, Matthieu, Bodin, Alexandre, Babuty, Dominique, Pierre, Bertrand, Clementy, Nicolas, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), CHU Marseille, Hôpital de la Timone [CHU - APHM] (TIMONE), Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Physiologie de la reproduction et des comportements [Nouzilly] (PRC), Institut Français du Cheval et de l'Equitation [Saumur] (IFCE)-Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i)

Subjects
medicine.medical_specialty, medicine.medical_treatment, Myocardial Ischemia, Cardiomyopathy, Cardiac resynchronization therapy, [SHS]Humanities and Social Sciences, Cardiac Resynchronization Therapy, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, Cardiac Resynchronization Therapy Devices, Aged, Heart Failure, business.industry, Mortality rate, Hazard ratio, Implantable cardioverter-defibrillator, medicine.disease, Confidence interval, Defibrillators, Implantable, Primary Prevention, Death, Sudden, Cardiac, Treatment Outcome, Heart failure, Population study, Cardiology and Cardiovascular Medicine, business
Abstract

Aims Cardiac resynchronization therapy with (CRTD) or without (CRTP) defibrillator is recommended in selected patient with systolic chronic heart failure and wide QRS. There is no guideline firmly indicating choice between CRTP and CRTD in primary prevention, particularly in older patients. Methods and results Based on the French administrative hospital-discharge database, information was collected from 2010 to 2017 for all patients implanted with CRTP or CRTD in primary prevention. Outcome analyses were undertaken in the total study population and in propensity-matched samples. During follow-up (913 days, SD 841, median 701, IQR 151–1493), 45 697 patients were analysed (CRTP 19 266 and CRTD 26 431). Incidence rate (%patient/year) of all-cause mortality was higher in CRTP patients (11.6%) than in CRTD patients (6.8%) [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.63–1.76, P Conclusion In this real-life study, CRTD was associated with a significantly lower all-cause mortality than CRTP in patients with ICM and in patients with NICM under 75 years old. Patients over 75 years old with NICM did not have lower mortality with primary prevention CRTD implantation.

Published
2020

3. Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions

Author

Sacher, Frederic, Fauchier, Laurent, Boveda, Serge, de Chillou, Christian, Defaye, Pascal, Deharo, Jean Claude, Gandjbakhch, Estelle, Probst, Vincent, Cohen, Ariel, Leclercq, Christophe, Bisson, Arnaud, Bodin, Alexandre, Herbert, Julien, Lacour, Thibaud, Saint Etienne, Christophe, Pierre, Bertrand, Clementy, Nicolas, Deharo, Pierre, Babuty, Dominique, Gaborit, Christophe, Lip, Gregory Y.H., Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), Clinique Pasteur, Clinique Pasteur [Toulouse], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), CHU Saint-Antoine [AP-HP], CHU Pontchaillou [Rennes], CHU Trousseau [APHP], Physiologie de la reproduction et des comportements [Nouzilly] (PRC), Institut Français du Cheval et de l'Equitation [Saumur] (IFCE)-Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), Service d'Information Médicale d'Epidemiologie et d'Economie de la Santé, University of Liverpool, Liverpool Heart & Chest Hospital, and Aalborg University [Denmark] (AAU)

Subjects
Male, medicine.medical_specialty, Databases, Factual, Disease, [SHS]Humanities and Social Sciences, Risk Factors, Thromboembolism, Internal medicine, Atrial Fibrillation, Humans, Medicine, In patient, Sinus (anatomy), Aged, Retrospective Studies, Aged, 80 and over, Sick Sinus Syndrome, Advanced and Specialized Nursing, business.industry, Incidence, Incidence (epidemiology), Node (networking), Atrial fibrillation, Middle Aged, medicine.disease, Stroke, medicine.anatomical_structure, Heart failure, Ischemic stroke, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Background and Purpose— Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated sinus node disease (SND) is unclear. We compared the incidence of IS in patients with SND, patients with AF, and in a control population with other cardiac diseases (disease of the circulatory system using the International Classification of Diseases, Tenth Revision ). Methods— This French longitudinal cohort study was based on the national database covering hospital care for the entire population from 2008 to 2015. Results— Of 1 692 157 patients included in the cohort, 100 366 had isolated SND, 1 564 270 had isolated AF, and 27 521 had AF associated with SND. Incidence of IS during follow-up was higher in isolated patients with AF than in AF associated with SND (yearly rate 2.22% versus 2.06%) and in isolated patients with AF than in isolated patients with SND (yearly rate 2.22% versus 1.59%). The incidence of IS was lower in a control population with other cardiac conditions (n=479 108) compared with SND and patients with AF (0.96%/y, 1.59%/y, and 2.22%/y, respectively). After 1:1 propensity score matching, SND was associated with lower incidence of IS compared to AF (hazard ratio, 0.77 [95% CI, 0.73–0.82]) but higher incidence of IS compared to control population (hazard ratio, 1.27 [95%CI, 1.19–1.35]). Conclusions— Patients with SND had a lower risk of thromboembolic events than patients with AF but a higher risk than a control population with other cardiac diseases. Randomized clinical trial in a selected SND population, with, for example, a high CHA 2 DS 2 -VASc score, would be required to determine the value of IS prevention by anticoagulation.

Published
2020

4. Supplemental Material - Elderly Outcomes After Hospitalization: The Hospital Frailty Risk Score Applied on the French Health Data Hub

Author

Dubnitskiy-Robin, Sophie, Laurent, Emeline, Herbert, Julien, Fougère, Bertrand, and Guillon-Grammatico, Leslie

Subjects
FOS: Clinical medicine, 111799 Public Health and Health Services not elsewhere classified, FOS: Health sciences, 110306 Endocrinology, 110308 Geriatrics and Gerontology
Abstract

Supplemental Material for Elderly Outcomes After Hospitalization: The Hospital Frailty Risk Score Applied on the French Health Data Hub by Sophie Dubnitskiy-Robin, Emeline Laurent, Julien Herbert, Bertrand Fougère and Leslie Guillon-Grammatico in Journal of Aging and Health

Published
2022
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5. Major Bleeding of Transjugular Native Kidney Biopsies. A French Nationwide Cohort Study

Author

Hindricks, Gerhard, Potpara, Tatjana, Dagres, Nikolaos, Arbelo, Elena, Bax, Jeroen, Blomström-Lundqvist, Carina, Boriani, Giuseppe, Castella, Manuel, Dan, Gheorghe-Andrei, Dilaveris, Polychronis, Fauchier, Laurent, Filippatos, Gerasimos, Kalman, Jonathan, La Meir, Mark, Lane, Deirdre, Lebeau, Jean-Pierre, Lettino, Maddalena, Lip, Gregory, Pinto, Fausto, Thomas, G Neil, Valgimigli, Marco, van Gelder, Isabelle, van Putte, Bart, Watkins, Caroline, Kirchhof, Paulus, Kühne, Michael, Aboyans, Victor, Ahlsson, Anders, Balsam, Pawel, Bauersachs, Johann, Benussi, Stefano, Brandes, Axel, Braunschweig, Frieder, Camm, a John, Capodanno, Davide, Casadei, Barbara, Conen, David, Crijns, Harry, Delgado, Victoria, Dobrev, Dobromir, Drexel, Heinz, Eckardt, Lars, Fitzsimons, Donna, Folliguet, Thierry, Gale, Chris, Gorenek, Bulent, Haeusler, Karl Georg, Heidbuchel, Hein, Iung, Bernard, Katus, Hugo, Kotecha, Dipak, Landmesser, Ulf, Leclercq, Christophe, Lewis, Basil, Mascherbauer, Julia, Merino, Jose Luis, Merkely, Béla, Mont, Lluís, Mueller, Christian, Nagy, Klaudia, Oldgren, Jonas, Pavlović, Nikola, Pedretti, Roberto, Petersen, Steffen, Piccini, Jonathan, Popescu, Bogdan, Pürerfellner, Helmut, Richter, Dimitrios, Roffi, Marco, Rubboli, Andrea, Scherr, Daniel, Schnabel, Renate, Simpson, Iain, Shlyakhto, Evgeny, Sinner, Moritz, Steffel, Jan, Sousa-Uva, Miguel, Suwalski, Piotr, Svetlosak, Martin, Touyz, Rhian, Neil Thomas, G, Delassi, Tahar, Sisakian, Hamayak, Chasnoits, Alexandr, Pauw, Michel De, Smajić, Elnur, Shalganov, Tchavdar, Avraamides, Panayiotis, Kautzner, Josef, Gerdes, Christian, Alaziz, Ahmad Abd, Kampus, Priit, Raatikainen, Pekka, Boveda, Serge, Papiashvili, Giorgi, Vassilikos, Vassilios, Csanádi, Zoltán, Arnar, David, Galvin, Joseph, Barsheshet, Alon, Caldarola, Pasquale, Rakisheva, Amina, Bytyçi, Ibadete, Kerimkulova, Alina, Kalejs, Oskars, Njeim, Mario, Puodziukynas, Aras, Groben, Laurent, Sammut, Mark, Grosu, Aurel, Boskovic, Aneta, Moustaghfir, Abdelhamid, Groot, Natasja De, Poposka, Lidija, Anfinsen, Ole-Gunnar, Mitkowski, Przemyslaw, Cavaco, Diogo Magalhães, Siliste, Calin, Mikhaylov, Evgeny, Bertelli, Luca, Kojic, Dejan, Hatala, Robert, Fras, Zlatko, Arribas, Fernando, Juhlin, Tord, Sticherling, Christian, Abid, Leila, Atar, Ilyas, Sychov, Oleg, Bates, Matthew, Zakirov, Nodir, Halimi, Jean-Michel, Gatault, Philippe, Longuet, Hélène, Barbet, Christelle, Goumard, Annabelle, Gueguen, Juliette, Goin, Nicolas, Sautenet, Bénédicte, Herbert, Julien, Bisson, Arnaud, Universität Leipzig [Leipzig], University of Belgrade [Belgrade], Leiden University Medical Center (LUMC), Uppsala University, Università degli Studi di Modena e Reggio Emilia, Colentina University Hospital, University of Medicine and Pharmacy 'Carol Davila' Bucharest (UMPCD), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), National and Kapodistrian University of Athens (NKUA), Université d'Athènes (UOA), Attikon University Hospital, The Royal Melbourne Hospital, University of Liverpool, San Gerardo Hospital of Monza, Aalborg University [Denmark] (AAU), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Faculdade de Medicina [Lisboa], Universidade de Lisboa (ULISBOA), Hospital de Santa Maria [Lisboa], Service de néphrologie et immunologie clinique [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, and Université de Nantes (UN)-Université de Nantes (UN)

Subjects
medicine.medical_specialty, Framingham Risk Score, Percutaneous, business.industry, medicine.medical_treatment, kidney biopsy, Retrospective cohort study, Odds ratio, Lower risk, medicine.disease, transjugular, Nephrectomy, Surgery, [SHS]Humanities and Social Sciences, bleeding score, Hematoma, percutaneous, Nephrology, Clinical Research, medicine, epidemiology, business, ComputingMilieux_MISCELLANEOUS, Cohort study
Abstract

Introduction The risk of bleeding associated with transjugular kidney biopsies is unclear, and which patients are the best candidates for this route is unknown. Methods This was a retrospective cohort study comparing proportion of bleeding associated with transjugular versus percutaneous native kidney biopsies in all patients in France in the 2010–2019 period. Major bleeding at day 8 (i.e., blood transfusions, hemorrhage/hematoma, angiographic intervention, nephrectomy) and risk of death at day 30 were assessed, and we used a bleeding risk score initially developed for the percutaneous route. Results Our analysis included 60,331 patients (transjugular route: 5305; percutaneous route: 55,026 patients). The observed proportion of major bleeding varied widely (transjugular vs. percutaneous): 0.4% versus 0.5% for the lowest risk scores (0–4) to 19.1% versus 30.8% for the highest risk scores (≥35). Transjugular was more frequently used than percutaneous route (39% vs. 24%) when the risk score was ≥20 (15,133/60,331; 25% of all patients). Transjugular was associated with a lower risk of major bleeding than percutaneous route in multivariate analyses (odds ratio [OR]: 0.88 [0.78–0.99]), especially for scores ≥20 (OR: 0.83 [0.72–0.96], (i.e., 25% of patients). Major bleeding was associated with an increased risk of death both for transjugular (OR: 1.77 [1.00–3.14]) and percutaneous (OR: 1.80 [1.43–2.28]) routes. Conclusions The transjugular route is independently associated with a lower risk of bleeding than the percutaneous route, especially in high-risk patients identified by a preprocedure risk score ≥20 (i.e., 25% of patients). Major bleeding is associated with an increased risk of death for both routes., Graphical abstract

Published
2021

7. Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: A nationwide cohort study

Author

Lantelme, Pierre, Bisson, Arnaud, Lacour, Thibaud, Herbert, Julien, Ivanes, Fabrice, Bourguignon, Thierry, Angoulvant, Denis, Harbaoui, Brahim, Bonnet, Marc, Babuty, Dominique, Saint Etienne, Christophe, Deharo, Pierre, Fauchier, Laurent, Pastori, Daniele, Marang, Amélie, Menichelli, Danilo, Lip, Gregory, Imagerie Ultrasonore, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), Institut de Socio-économie des Entreprises et des ORganisations (ISEOR), Institut de socio-économie des entreprises et des organisations, Laboratoire de Recherche Magellan, Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Institut d'Administration des Entreprises (IAE) - Lyon, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), University of Liverpool, and Aalborg University [Denmark] (AAU)

Subjects
Adult, Cancer Research, medicine.medical_specialty, Hemorrhage, Gastroenterology, Risk Assessment, [SHS]Humanities and Social Sciences, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Uterine cancer, Risk Factors, Internal medicine, Neoplasms, Thromboembolism, Atrial Fibrillation, medicine, cancer, Humans, 030212 general & internal medicine, atrial fibrillation, bleeding, mortality, stroke, thromboembolism, Lung cancer, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, business.industry, Cancer, Retrospective cohort study, medicine.disease, Oncology, 030220 oncology & carcinogenesis, Liver function, Liver cancer, business
Abstract

Background The number of patients with atrial fibrillation (AF) and cancer is rapidly increasing in clinical practice. The impact of cancer on clinical outcomes in this patient population is unclear, as is the performance of the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol) and CHA2 DS2 -VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes Mellitus, Stroke or Transient Ischemic Attack, Vascular Disease, Age 65 to 74 Years, Sex Category) scores. Methods This was an observational, retrospective cohort study including 2,435,541 adults hospitalized with AF. The authors investigated the incidence rates (IRs) of all-cause and cardiovascular mortality, ischemic stroke, major bleeding, and intracranial hemorrhage (ICH) according to the presence of cancer and cancer types. Results Overall, 399,344 (16.4%) had cancer, with the most common cancers being metastatic, prostatic, colorectal, lung, breast, and bladder. During a mean follow-up of 2.0 years, cancer increased all-cause mortality (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.99-2.01). The IR of ischemic stroke was higher with pancreatic cancer (2.8%/y), uterine cancer (2.6%/y), and breast cancer (2.6%/y), whereas it was lower with liver/lung cancer (1.9%/y) and leukemia/myeloma (2.0%/y), in comparison with noncancer patients (2.4%/y). Cancer increased the risk of major bleeding (HR, 1.27; 95% CI, 1.26-1.28) and ICH (HR, 1.07; 95% CI, 1.05-1.10). Leukemia, liver cancer, myeloma, and metastatic cancers showed the highest IRs for major bleeding/ICH. Major bleeding and ICH rates progressively increased with the HAS-BLED score, which showed generally good predictivity with C indexes > 0.70 for all cancer types. The CHA2 DS2 -VASc score's predictivity was slightly lower in AF patients with cancer. Conclusions Cancer increased all-cause mortality, major bleeding, and ICH risk in AF patients. The association between cancer and ischemic stroke differed among cancer types, and in some types, the risk of bleeding seemed to exceed the thromboembolic risk.

Published
2020

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