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The Use of Biomarkers to Predict Specific Causes of Death in Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial.

著者 Sharma A , Hijazi Z , Andersson U , Al-Khatib SM , Lopes RD , Alexander JH , Held C , Hylek EM , Leonardi S , Hanna M , Ezekowitz JA , Siegbahn A , Granger CB , Wallentin L
Circulation.2018 Jun 05 ; ():.
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-Atrial fibrillation (AF) is associated with an increased risk of death. High-sensitivity troponin-T, growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and interleukin-6 levels are predictive of cardiovascular (CV) events and total and CV death in anticoagulated AF patients. The prognostic utility of these biomarkers for cause-specific death is unknown. -The ARISTOTLE trial randomized 18,201 patients with AF to apixaban or warfarin. Biomarkers were measured at randomization in 14,798 patients (1.9 years median follow-up). Cox-models were used to identify clinical variables and biomarkers independently associated with each specific cause of death. -In total 1,272 patients died: 652 (51%) CV; 32 (3%) bleeding; and 588 (46%) non-CV/non-bleeding deaths. Among CV-deaths, 255 (39%) were sudden cardiac deaths, 168 (26%) heart failure (HF), and 106 stroke/systemic embolism (SE) (16%) deaths. Biomarkers were the strongest predictors of cause-specific death: a doubling of troponin-T was most strongly associated with sudden death (HR 1.48; p<0.001), NT-proBNP with HF death (HR 1.62; p<0.001), and GDF-15 with bleeding death (HR 1.72; p=0.028). Prior stroke/SE (HR 2.58; p>0.001) followed by troponin-T (HR 1.45; p<0.0029) were the most predictive for stroke/SE death. Adding all biomarkers to clinical variables improved discrimination for each cause-specific death. -Biomarkers were some of the strongest predictors of cause-specific death and may improve the ability to discriminate among patients' risks for different causes of death. These data suggest a potential role of biomarkers for identification of patients at risk for different causes of death in patients anticoagulated for AF. -URL: https://www.clinicaltrials.gov Unique Identifier: NCT00412984.
PMID: 29871978 [PubMed - as supplied by publisher]
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