Key result
Gastrointestinal cancer in atrial fibrillation patients was associated with increased MACE risk (HR 3.22; 95% CI 1.59-6.52; P=0.001), and respiratory cancer with increased thromboembolism risk.
Why the study?
Cancer may complicate the clinical course of nonvalvular AF, but its association with cardiovascular events remains unclear.
Does the presence and specific site of cancer increase the risk of cardiovascular events in elderly patients with atrial fibrillation on vitamin K antagonists?
Cohort (n=2,092)
Does the presence and specific site of cancer increase the risk of cardiovascular events in elderly patients with atrial fibrillation on vitamin K antagonists?
In patients with atrial fibrillation on vitamin K antagonists, the risk of ischemic complications varies by cancer site, with gastrointestinal cancer increasing MACE risk and respiratory cancer increasing thromboembolism risk.
Answers are grounded in this paper and cite their sources.
May heighten vigilance for MACE or thromboembolism by cancer site in AF on VKA; leaves open prospective validation before practice change.
Cancer may complicate the clinical course of nonvalvular atrial fibrillation (AF) but its association with cardiovascular events (CVEs) remains unclear. We performed a prospective cohort study including 2092 consecutive AF patients on vitamin K antagonists. Principal endpoint was the occurrence of CVEs including fatal/nonfatal myocardial infarction and ischemic stroke/transient ischemic attack and cardiovascular death. Secondary endpoints were major adverse cardiac events (MACEs) and thromboembolism (TE). Mean age was 73.7 ± 9.1 years and 42.1% were women; 367 (17.5%) patients had cancer: 21% gastrointestinal (GI), 10% respiratory, 28% genitourinary and 41% had other localization. Cancer patients were older but with similar comorbidities than those without. During a mean of 35.9 months, 203 CVEs occurred (incidence rate [IR] = 3.24 per 100 patient-years): 133 MACEs (IR = 2.12 per 100 patient-years) and 70 TE (IR = 1.12 per 100 patient-years). Multivariable Cox proportional hazards regression analysis showed an association between GI cancer and MACE occurrence (hazard ratio [HR] = 3.22, 95% confidence interval [CI] = 1.59-6.52, P = .001) and between respiratory cancer and TE (HR = 3.37, 95% CI = 1.30-8.75, P = .013). These associations were confirmed at competing risk analysis. In conclusion, AF patients with cancer have specific vascular outcomes according to cancer site, as indicated by the higher risk of MACE and TE in patients with gastrointestinal and respiratory cancer, respectively.
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Pastori et al. (2020) conducted a cohort in nonvalvular atrial fibrillation (AF) (n=2,092). Cancer vs. No cancer was evaluated on occurrence of cardiovascular events (CVEs) including fatal/nonfatal myocardial infarction and ischemic stroke/transient ischemic attack and cardiovascular death. Gastrointestinal cancer in atrial fibrillation patients was associated with increased MACE risk (HR 3.22; 95% CI 1.59-6.52; P=0.001), and respiratory cancer with increased thromboembolism risk.
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