Key result
High CRP and elevated WBCs are linked to ~45% higher AHRE risk in CIED patients.
Why the study?
The characteristics of real-world patients developing atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices are poorly known.
Are inflammatory markers associated with the risk of atrial high-rate episodes in patients with cardiac implantable electronic devices?
Cohort (n=496)
No
Are inflammatory markers associated with the risk of atrial high-rate episodes in patients with cardiac implantable electronic devices?
Hazard Ratio: 1.449 (95% CI 1.021–2.056)
p-value: p=0.038
In patients with CIEDs, age, prior AF, and inflammatory markers (CRP, white cell count) are independently associated with the onset of atrial high-rate episodes, while clinical risk scores have limited predictive value.
May refine AHRE monitoring in CIED patients; leaves open whether predictors alter anticoagulation or outcomes in trials.
Atrial high-rate episodes (AHREs) are associated with an increased risk of developing atrial fibrillation and thromboembolism. The characteristics of ‘real world’ patients developing AHREs are poorly known. We included 496 consecutive patients with cardiac implantable electronic devices (CIEDs). Primary endpoint was occurrence of AHREs, defined as > 175 bpm and lasting > 5 min, in a median follow-up of 16.5 (IQR 3.9–38.6) months (1082.4 patient-years). We also tested the predictive value of clinical risk scores for AHREs. Mean age was 68.8 ± 14.0 years, and 35.5% were women; AHREs were recorded in 173 patients [34.7%, 16.0%/year, 95% confidence interval (CI) 13.7–18.6]. Multivariable Cox regression analysis showed that age [hazard ratio (HR) 1.020, 95% CI 1.004–1.035, p = 0.011], prior AF (HR 3.521, 95% CI 2.831–5.206, p < 0.001), white cell count (HR 1.039, 95% CI 1.007–1.072, p = 0.016) and high C reactive protein (CRP; HR 1.039, 95% CI 1.021–2.056, p = 0.038) were independently associated with AHREs. ROC curve analysis showed that the APPLE score ( C statistic 0.53, 95% CI 0.48–0.59; p = 0.296) ALARMEc score ( C statistic 0.51, 95% CI 0.44–0.57; p = 0.810) were non-significantly associated with AHRE. Similar results were obtained for CHADS 2 and CHA 2 DS 2 VASc score AHREs are common in CIEDs patients, with age, prior AF, inflammatory markers (high CRP, white cell count) being factors associated with AHREs onset. Clinical risk scores showed limited value for AHREs prediction in this cohort.
No takes yet. Share an insight, caveat, or question.
Pastori et al. (2018) conducted a cohort in Cardiac implantable electronic devices (CIEDs) (n=496). High C-reactive protein (CRP) vs. Low C-reactive protein (below median) was evaluated on Occurrence of atrial high-rate episodes (AHREs) >175 bpm lasting >5 min (HR 1.449, 95% CI 1.021-2.056, p=0.038). In patients with cardiac implantable electronic devices, high C-reactive protein (HR 1.449) and elevated white cell count were independently associated with the onset of atrial high-rate episodes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: