Cause of Death and Predictors of All‐Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation: Data From ROCKET AF

著者: Sean D. Pokorney, Jonathan P. Piccini, Susanna R. Stevens, Manesh R. Patel, Karen S. Pieper, Jonathan L. Halperin, Günter Breithardt, Daniel E. Singer, Graeme J. Hankey, Werner Hacke, Richard C. Becker, Scott D. Berkowitz, Christopher C. Nessel, Kenneth W. Mahaffey, Keith A.A. Fox, Robert M. Califf, J. Anderson, Noel W. Bedwell, Martin Bilsker, G. Keith Bruce, Ramtin Agah, M Desantis, Steven Eisenberg, A. Flores, Wolfgang Herzog, S Klein, H. Snyder, Steven K. Krueger, Erasmo de la Peña-Almaguer, EFI LAVIE, C. Lee, G. Mallis, Manish Modi, Graeme F. Woodworth, I. Niazi, Brenda Peart, Sri Sundaram, Brian Snoddy, Rodolfo Sotolongo, John B. Moloney, Kris Vijayaraghavan, F. Whittier, L. Yellen, Subhash Banerjee, Daniel L. Lustgarten, Dr.S Suresh, M. Gelernt, L Levinson, R. Ghanekar, G. Larsen Kneller, Christian Hall, Yazid Y. Fadl, Mark J. Pirwitz, William J. French, Nolan Mayer, Jian Bianca Pugeda, Kevin Steel, Freny Vaghaiwalla Mody, Amir Malik, H. Chandna, Alan S. Go, George Emlein, William W Bowden, Roberto Moscoso, Ruth Hodson, Michael Berk, Dengji Pan, Janine Pappas, Robert C. Orchard, G. Lynchard, Nampalli Vijay, Waqor Khan, Maher Khadra, Mark C Antonishen, Fred Cucher, Michael E. Staab, James S. Zebrack, S Borromeo, Jacqueline M. Heilman, Seemant Chaturvedi, Sravya Makam, Samir Turk, Thomas M. Hyers, George W. Williams, Ajay Labroo, SK Gill, Donald W. Myears, Jean Marc Weinstein, Jeffrey G. Shanes, Y. Chandrashekhar, Surbhi Shah, William M. Reiter, Tim Logemann, Adrian K. Almquist, Ravi Bhagwat, Tahir Tak, J. Shen‐Ling, Priyesh Patel, Andre Artis, Amy Arouni, Michael R. Lauer, Kurt G. Kinney, J. Elsen, P G Roan, R. Villafria, Matthew T. Sumpter, James E. Ip, Stephen Welka, Branislav Schifferdecker, R. Sandoval, S. Speirs, Aubrey Jones, Thomas Haldis, John F. Kazmierski, Julie Sutherland, Denise Felber Dietrich, Edward Telfer, Joni I. Berry, Alvin Mcelveen, James K. Russell, Melanie K. Sackett, Nathalie Antonios, David W. Smith, Kishor Vora, Ann Kirby, Hin-Wai LUI, David M. Mego, Khaled M. Ziada, José Casals Navas, Andrew Taussig, Michael J. Koren, Craig Vogel, F. Saba, Charles W. Parrott, R. Schneider, Arsalan Shirwany, Mark N. Rubin, Charles B. Treasure, Barry Bertolet, Mark Chang, Jonathan J. Langberg, Richard C. Becker, Yves Cohen, Frank McGrew, Jentora White, F. Arzola, J Zelenka, A. Tannenbaum, Vera Fernandes, P. Jamnadas, J. Agamasu, Bradley Collins, W. Jauch, Brett Sasseen, David R. Hotchkiss, R. Abadier, A. Osunkoya, A. Schlau, C. I. Chappel, Malcolm Foster, Eyal Braun, Edward Mostel, Jaïr Dilmé Capó, Majdi Ashchi, Virginia J. Howard, Abdulhay Albirini, Alfred Burger, Daniel M. Rolston, Cezar Staniloae, Jenny Bacon, Anthony Wiseman, Jeremy R. McGarvey, Ali F. Sonel, Glenn S. Hamroff, Donald Chang, Nizar Daboul, George Broderick, A. Meholick, John Corbelli, R Silverman, J.D. Raffetto, Robert Fishberg, Steven Georgeson, Jolene Held, Matt Seidner, Henock Saint-Jacques, John F. Heitner, Steven P. 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Sancho Saldaña, Eduardo Garcés, L. Bunster, H. Figueroa, Claudia Olivares, Carmelo Raffo, E. Vergara, Pablo Sepúlveda, Gabriel Jano, Jacqueline Alvarado, Rafael Suárez, M. Urina, Gabriela Perez, Andres Quintero, L. Fernando Pava, Ralph Lopez, Carlos Luengas, Edgar J. Hernández, David Martí Sánchez, Cristina Poveda, Julián Coronel, Raúl Carrillo Beltrán, Carlos Jaramillo, J. Pardo, C. Ponte Negretti, Jesús Isea, Gastón Vergara-Hermosilla, Igor Morr, K.H. Sim, Waheed Ahmad, Zurkurnai Yusof, Azhari Rosman, Hamidon Basri, Paul A. Thompson, Ian Jeffery, P. Purnell, P J Roberts-Thomson, William Heddle, J. Waites, D. Walters, John Amerena, Pavan Challa, Jeff Karrasch, A Lowy, David Fitzpatrick, MW Parsons, Thanh G. Phan, Christopher Bladin, Geoffrey A. Donnan, G. Aroney, Richard Gerraty, Craig S. Anderson, Peter Blombery, Paul Martín, Tissa Wijeratne, D. Cross, Denis Crimmins, David Packham, Daniel Jackson, Winnie Chua, Rosa María García Merino, Michael G. Magno, Louie Tirador, Elfred B. Batalla, Chriselda G Manalo, Natalie Uy, Geraldine Ebo, Eugene B. Reyes, Alisa Bernan, Mark Richards, Hamish Hart, Samuel J. Mann, Raewyn Fisher, Ralph Stewart, Gerard Wilkins, A. J. Barber, Ru‐San Tan, Hean Yee Ong, Robby Singh, Apichard Sukonthasarn, Supachai Tanomsup, Rungroj Krittayaphong, Chumpol Piamsomboon, Dilok Piyayotai, Buncha Sunsaneewitayakul, Sang Hong Baek, H. Seo, Se‐Joong Rim, C. Kim, K. Kim, Kum Hei Ryu, Ström JO, S J Tahk, H. Lee, Y. Kim, Dong‐Gu Shin, Youngsook Choi, N. Chung, June Namgung, Taek Jong Hong, Wan-Sik Shin, Song Jin, Xue Yan, Guohua Fu, Genmin Lu, Kuang-Tsu Yang, Dong Xu, Jocelyn Chen, Jun G Liu, Shuyi Wu, Ji Young Song, Ying‐Chieh Liao, Bin Xu, Z. Li, Shuren Ma, Yiwei Yin, Yingxin Zhao, Dayi Hu, Changsheng Ma, Jianyong Ma, J F Sun, H. Li, Xuejiao Hong, Ben Hui Yu, Qiang Lü, Jian Yang, Zhaohui Wu, Y. Li, Yu‐Tung Huang, Y. Wang, M. Liu, Yun‐Jiu Cheng, Ten-Fang Yang, K. Chen, H. Wang, Zuyi Yuan, J. Wang, Zhiwei Zeng, Y. Chen, O. Yavuzgil, Ömer Kozan, Mumin Etemoglu, Erdem Diker, A Belgi, Ceyhun Ceyhan, V. Cin, Ömer Yılmaz, Naim Ata, Bülent Behlül Altunkeser, Ayşen Ağaçdiken Ağır, Aziz Karadede, Ramazan Topsakal, Rajiv Gulati, Arjun Madhavan, Sandeep Jain, Abraham Oomman, Satej Janorkar, Pradeep Kumar, Ajay Naik, Hemant Thacker, V. Rajasekhar, Ramakota Reddy, C B Keshavamurthy, Pankaj Jain, B. Gowdappa, Milind Gadkari, Atul Abhyankar, B. Ramesh Babu, P.R. Vydianathan, Sunil Sinha, Neha Garg, Shufang Rao, PL Gautam, K. Chockalingam, Mukund Kumbla, Rajesh Panwar, Darshan Banker, Markku Kaste, Pekka Jäkälä, Risto O. Roine, Atanas Mihov, Dimitar Raev, V. Yordanova, S. Dimitrova, Haralambi O Benov, Veska Tsanova, M. Kyolean, S. Marchev, Anastas Stoikov, Nikolai G. Zdravkov, K. Ramshev, A. Krastev, P. Stamenova, I Angelova, G. Pencheva, Valentina Grigorova, Birutė Petrauskienė, I. Skripkauskiene, Rasa Raugalienė, Sigutė Norkienė, R. Mazutavicius, Aušra Kavoliūnienė, Sigita Aidietienė, Jūratė Aganauskienė, A. Dailydkiene, Jolanta Elena Marcinkevičienė, L. Grigoniene, J. Anusauskiene, Roma Kavaliauskiene, V. G. Lizogub, Л И Руденко, Vira Tseluyko, Л. Г. Воронков, O. S. Sychov, Yevgeniya Svyshchenko, Yu.M. Sіrenko, В К Серкова, N.M. Seredyuk, Tetyana Pertseva, V. Z. Netyazhenko, Viktoriia Y Lishnevska, O. Kupchynska, Olena Koval, Г Н Кошукова, Oleksandr Karpenko, O. Grishyna, A. Faynyk, G. V. Dzyak, O. Dyadyk, L.M. Yena, В Е Волков, Iurii Rudyk, M. P. Kopytsya, L. Kononenko, Amosova En, S Zhurba, V. Kazimirko, I. Iuzkiv, O. Shershnyova, Tetyana Khomazyuk, Valeriy Batushkin, I. Vykhovanyuk, G. Popik, V. Skrebkov, A. Skurtov, Т С Мищенко, N. V. Lytvynenko, Л. И. Соколова, M. T. Vatutin, М. І. Швед, Б. А. Ребров, L. Kadina, M. Vajda, Григорий Николаевич Урсол, V. Zheleznyy, T.G. Vysochanska, А. І. Гоженко, K Fan, D. Ho, Hung‐Fat Tse, Cheuk‐Man Yu, Ka Sing Wong, Hung‐I Yeh, Paresh Pai, Ching‐Lin Hsieh, Chun‐Yao Huang, Yu‐Cheng Hsieh, Wei-Hsian Yin, L M Tsai, Ting‐Chun Huang, C. Chen, Fu‐Tien Chiang, K.-C. Ueng, Min Ji Charng, Alon Marmor, Amos Katz, Adi Butnaru, Basil S. Lewis, M. Eldar, S. Rosenhack, Nora Elias, Bella Koifman, Michael Shochat, Moshe Swissa, Reuven Zimlichman, Tamir Bental, A. Weiss, Rasem Ganam, Merrill F. Elias, William Nseir, Arie Oliven, Benjamin Brenner, Molly Dayan - Journal of the American Heart Association 2016 被引用: 200

BACKGROUND: Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. METHODS AND RESULTS: 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) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P<0.0001) were associated with higher all-cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C-index 0.677). CONCLUSIONS: In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.