Early rhythm control reduced cardiovascular events consistently across 13 of 14 biomarker concentrations, with a potentially attenuated effect in patients in the lowest BMP10 quintile.
RCT (n=1,586)
Randomized
Does early rhythm control reduce cardiovascular events consistently across different biomarker profiles in patients with atrial fibrillation?
Early rhythm control is consistently effective in reducing cardiovascular events in atrial fibrillation patients regardless of baseline biomarker concentrations, with a possible exception of low BMP10 levels.
BACKGROUND: Early rhythm control reduces cardiovascular events in patients with atrial fibrillation (AF) and cardiovascular comorbidities. Whether this effect is consistent across severities of different AF-associated conditions is not known. METHODS: In the EAST-AFNET 4 biomolecule study (n=1,586; median age 70 years; 45% women), 14 circulating biomarkers reflecting inflammation, fibrosis, ageing, cardiac strain, and myocardial damage were quantified. Log-transformed, winsorized biomarkers were analysed in quintiles to detect non-linear associations and as continuous parameters. Cox proportional hazards models evaluated associations with the primary outcome (cardiovascular death, stroke, or unplanned hospitalization for heart failure or acute coronary syndrome) and the safety outcome (death, stroke, or major bleeding) of the trial, including interaction terms for biomarkers and randomized treatment (early rhythm control ERC vs usual care). UC). Two independent cohorts, BBC-AF resembling UC and a TRUST snapshot resembling ERC were combined for external replication. All tests were exploratory. RESULTS: ERC reduced the primary outcome consistently across biomarker concentrations. No signal for treatment interaction was observed for 13 of 14 biomarkers for the primary outcome. For BMP10, a nominal interaction was observed in categorical analyses, suggesting an attenuated treatment effect of ERC in patients in the lowest BMP10 quintile. No interaction was detected for continuous parameters. Similar patterns were observed in exploratory analyses of the replication cohort. CONCLUSIONS: Early rhythm control therapy is effective across patients with different severities of conditions associated with atrial fibrillation as quantified by biomolecule concentrations. A potentially attenuated effect of ERC with low BMP10 concentrations warrants further research.
Al-Taie et al. (Mon,) conducted a rct in Atrial fibrillation (n=1,586). Early rhythm control vs. Usual care was evaluated on Cardiovascular death, stroke, or unplanned hospitalization for heart failure or acute coronary syndrome. Early rhythm control reduced cardiovascular events consistently across 13 of 14 biomarker concentrations, with a potentially attenuated effect in patients in the lowest BMP10 quintile.