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Clinical Summary

CKD Not Independently Associated With MACE in Patients With AF

Takeaway

  • The presence of chronic kidney disease (CKD) was not independently associated with major adverse cardiovascular events (MACE) in patients with atrial fibrillation (AF).
  • The 2MACE score may be a useful tool for clinical risk stratification of high-risk AF patients with CKD, and those at high MACE risk could be targeted for more intensive cardiovascular (CV) prevention strategies.

Why This Matters

  • AF and CKD are closely related conditions; however, the effect of CKD on MACE in patients with AF has not been investigated.

Study Design

  • A post hoc analysis of the AMADEUS trial included 4554 patients with AF (716 CKD and 3838 non-CKD patients).
  • Primary outcome: MACE (composite of myocardial infarction, cardiac revascularization and CV mortality).
  • Secondary outcomes: other clinically relevant events (OCREs; defined as a composite of stroke, major bleeding and non-CV mortality) and each of the specific outcomes.
  • Funding: None disclosed.

Key Results

  • The incidence of CV and non-CV mortality was 1.41% and 2.44% per 100 patient-years, respectively.
  • No significant difference was seen between CKD and non-CKD groups in crude incidences of:
    • MACEs (HR, 0.53; 95% CI, 0.24 - 1.14; P = .104); and
    • OCREs (HR, 0.66; 95% CI, 0.43 - 1.01; P = .054).
  • In multivariable regression analysis, CKD was not independently associated with MACE (HR, 1.03; 95% CI, 0.45 - 2.34).
  • The area under the curve of the 2MACE score for prediction of MACE was 0.65 (95% CI, 0.59-0.71; P < .001).
  • In the presence of CKD, each additional point of the 2MACE score contributed to a greater risk of MACE (HR, 3.17 [95% CI, 1.28 - 7.85] vs 1.48 [95% CI, 1.17 - 1.87]).

Limitation

  • Post hoc analysis.

Ding WY, Lip GYH, Pastori D, Shantsila A. Effects of atrial fibrillation and chronic kidney disease on major adverse cardiovascular events. Am J Cardiol. 2020 Jul 11 [Epub ahead of print]. doi:10.1016/j.amjcard.2020.07.004. PMID: 32773222

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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