Urinary 11-dehydro-thromboxane B₂ is associated with cardiovascular events and mortality in patients with atrial fibrillation

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• 作者：Daniele Pastori ; MD^a ; ^f ; Pasquale Pignatelli ; MD^a ; ^f ; Alessio Farcomeni ; PhD^b ; Roberto Cangemi ; MD^a ; William R. Hiatt ; MD^c ; Simona Bartimoccia ; PhD^a ; Cristina Nocella ; PhD^a ; Tommasa Vicario ; MD^a ; Tommaso Bucci ; MD^a ; Roberto Carnevale ; PhD^a ; ^d ; Gregory Y.H. Lip ; MD^e ; Francesco Violi ; MD^a ; ^{francesco.violi@uniroma1.it" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Heart Journal
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：170
• 期：3
• 页码：490-497.e1
• 全文大小：319 K

文摘

Patients with nonvalvular atrial fibrillation (AF) show high residual cardiovascular (CV) risk despite oral anticoagulants. Urinary 11-dehydro-thromboxane B2 (TxB₂) is associated with an increased risk of CV events (CVEs), but its predictive value in patients with anticoagulated AF is unknown.

Methods

A prospective single-center cohort study, including 837 patients with AF, was conducted. Mean time of follow-up was 30.0 months, yielding 2,062 person-years of observation. Urinary 11-dehydro-TxB₂ was measured at baseline. The primary end point was the occurrence of a CVE including fatal/nonfatal myocardial infarction and ischemic stroke, transient ischemic attack, cardiac revascularization, and CV death.

Results

Mean age of patients was 73.1 years, and 43.6% were women. Median 11-dehydro-TxB₂ levels were 100 (interquartile range 50-187) ng/mg of urinary creatinine. Overall, the anticoagulation control was adequate (63.9% of mean time in therapeutic range). A CVE occurred in 99 (11.8%) patients, and 55 were CV deaths. At baseline, 11-dehydro-TxB₂ levels were higher in patients with a CVE compared with those without (186 [107-400] vs 98 [52-170], P < .001). An increased rate of CVEs (log-rank test, P < .001) and CV deaths (P < .001) was observed across tertiles of 11-dehydro-TxB₂.

Cardiovascular events were associated with age (hazard ratios [HR] 1.72 per 1 SD, 95% CI 1.33-2.21, P < .001), diabetes mellitus (HR 1.89, 95% CI 1.20-2.96, P = .005), heart failure (HR 1.60, 95% CI 1.01-2.54, P = .044), history of stroke/transient ischemic attack (HR 1.96, 95% CI 1.25-3.06, P = .003), and 11-dehydro-TxB₂ (HR 1.64 per 1 SD, 95% CI 1.42-1.89, P < .001).

Conclusions

Urinary 11-dehydro-TxB₂ levels are associated with a residual risk of CVEs and CV mortality in patients with AF despite anticoagulant treatment.