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Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial.

Publication ,  Journal Article
Steinberg, BA; Hellkamp, AS; Lokhnygina, Y; Patel, MR; Breithardt, G; Hankey, GJ; Becker, RC; Singer, DE; Halperin, JL; Hacke, W; Nessel, CC ...
Published in: Eur Heart J
February 1, 2015

AIM: Anticoagulation prophylaxis for stroke is recommended for at-risk patients with either persistent or paroxysmal atrial fibrillation (AF). We compared outcomes in patients with persistent vs. paroxysmal AF receiving oral anticoagulation. METHODS AND RESULTS: Patients randomized in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) trial (n = 14 264) were grouped by baseline AF category: paroxysmal or persistent. Multivariable adjustment was performed to compare thrombo-embolic events, bleeding, and death between groups, in high-risk subgroups, and across treatment assignment (rivaroxaban or warfarin). Of 14 062 patients, 11 548 (82%) had persistent AF and 2514 (18%) had paroxysmal AF. Patients with persistent AF were marginally older (73 vs. 72, P = 0.03), less likely female (39 vs. 45%, P < 0.0001), and more likely to have previously used vitamin K antagonists (64 vs. 56%, P < 0.0001) compared with patients with paroxysmal AF. In patients randomized to warfarin, time in therapeutic range was similar (58 vs. 57%, P = 0.94). Patients with persistent AF had higher adjusted rates of stroke or systemic embolism (2.18 vs. 1.73 events per 100-patient-years, P = 0.048) and all-cause mortality (4.78 vs. 3.52, P = 0.006). Rates of major bleeding were similar (3.55 vs. 3.31, P = 0.77). Rates of stroke or systemic embolism in both types of AF did not differ by treatment assignment (rivaroxaban vs. warfarin, Pinteraction = 0.6). CONCLUSION: In patients with AF at moderate-to-high risk of stroke receiving anticoagulation, those with persistent AF have a higher risk of thrombo-embolic events and worse survival compared with paroxysmal AF.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

February 1, 2015

Volume

36

Issue

5

Start / End Page

288 / 296

Location

England

Related Subject Headings

  • Warfarin
  • Vitamin K
  • Treatment Outcome
  • Thiophenes
  • Stroke
  • Rivaroxaban
  • Risk Factors
  • Prospective Studies
  • Morpholines
  • Male
 

Citation

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Steinberg, B. A., Hellkamp, A. S., Lokhnygina, Y., Patel, M. R., Breithardt, G., Hankey, G. J., … ROCKET-AF Steering Committee and Investigators, . (2015). Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J, 36(5), 288–296. https://doi.org/10.1093/eurheartj/ehu359
Steinberg, Benjamin A., Anne S. Hellkamp, Yuliya Lokhnygina, Manesh R. Patel, Günter Breithardt, Graeme J. Hankey, Richard C. Becker, et al. “Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial.Eur Heart J 36, no. 5 (February 1, 2015): 288–96. https://doi.org/10.1093/eurheartj/ehu359.
Steinberg BA, Hellkamp AS, Lokhnygina Y, Patel MR, Breithardt G, Hankey GJ, et al. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J. 2015 Feb 1;36(5):288–96.
Steinberg, Benjamin A., et al. “Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial.Eur Heart J, vol. 36, no. 5, Feb. 2015, pp. 288–96. Pubmed, doi:10.1093/eurheartj/ehu359.
Steinberg BA, Hellkamp AS, Lokhnygina Y, Patel MR, Breithardt G, Hankey GJ, Becker RC, Singer DE, Halperin JL, Hacke W, Nessel CC, Berkowitz SD, Mahaffey KW, Fox KAA, Califf RM, Piccini JP, ROCKET-AF Steering Committee and Investigators. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J. 2015 Feb 1;36(5):288–296.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

February 1, 2015

Volume

36

Issue

5

Start / End Page

288 / 296

Location

England

Related Subject Headings

  • Warfarin
  • Vitamin K
  • Treatment Outcome
  • Thiophenes
  • Stroke
  • Rivaroxaban
  • Risk Factors
  • Prospective Studies
  • Morpholines
  • Male