BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn 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 CHADS 2 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).ConclusionsIn 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.
The aim – to study the clinical, anamnestic and instrumental parameters associated with short-term prognosis in patients with pulmonary embolism (PE). Materials and methods. This study was conducted from September 1, 2019 to December 31, 2020 on the basis of the city clinical hospital. The preliminary analysis included 187 patients with acute pulmonary embolism. The study found that 25 (13.3 %) patients died within 30 days (group I): 19 (76.0 %) patients belonged to a high risk of predicted early death and 6 (24.0 %) – to intermediate-high risk. For further analysis, a comparison group (group II) was formed and included 106 (56.7 %) patients who survived within 30 days of the onset of an acute episode of PE: 54 (50.9 %) patients belonged to high risk, 52 (49.1 %) – to intermediate high risk. All patients with pulmonary embolism received anticoagulant therapy according to the current ESC guidelines. Results. The average age of patients in group I was 69.08 ± 14.15 years and was significantly higher than in group II: 65.25 ± 13.29 (p = 0.0169). The proportion of high-risk patients was significantly greater in the І group, the proportion of patients of intermediate-high risk was significantly greater in group II (p = 0.0409). The incidence of classes IV and V according to the PESI index, assessed in patients of intermediate-high risk, was the same in both groups, while patients with the PESI index class III prevailed in group II (p = 0.0380). The risk factors for venous thromboembolism occurred more frequently in patients of group I, i.e. congestive heart failure (p = 0.0065) and obesity (p = 0.0482). Conclusions. There is a high mortality rate within 30 days (13.3 %) in hospitalized patients with acute PE, including 26 % of high-risk patients and 10.3 % of intermediate-high risk. Age over 65 years, the presence of congestive heart failure and obesity are independent factors that, according to uni- and multivariate logistic regression analysis, are associated with poor short-term prognosis in patients with PE. Key words: pulmonary embolism, venous thromboembolism, short-term prognosis, anticoagulant therapy.
Background. The purpose was the analysis of the features of the course and the leading factors in the development of pulmonary embolism. Materials and methods. During the period from November 1, 2019, to December 2020, inclusive, 188 patients with acute pulmonary embolism (PE), aged 46 to 80 years old, were hospitalized at the City Clinical Hospital 8 of the Kharkiv City Council; the average age was 62.9 ± 16.7 years. In-hospital mortality was 12.2 % (23 patients). The criterion for inclusion in the study was acute PE, which was diagnosed based on the results of multislice computed tomographic angiography of the pulmonary arteries (MCT angiography of the pulmonary arteries). All patients underwent a general clinical examination, the risk and prognosis were assessed based on the generally accepted scales, standard transthoracic echocardiography (EchoCG), and Doppler ultrasound examination of the veins of the lower extremities were performed. Results. The disease was diagnosed with the same frequency in men and women; there was no difference in age. Among the most significant and important risk factors for the development of pulmonary embolism are the history of venous thrombosis/embolism and active malignant oncological disease (43 and 35 %, respectively), while the less significant ones were advanced age, varicose veins of the lower extremities and arterial hypertension 47.9, 31.4 and 52.1 %, respectively. The vast majority (57.4 %) had a combination of 2 or more risk factors. Signs of right ventricular dysfunction according to MCT angiography of the pulmonary arteries and/or echocardiography were recorded in 45.7 % of patients. A high and medium-high risk of early death associated with acute PE was found in a significant percentage (71.8 %) of patients, which required the inclusion of a thrombolytic agent in the treatment strategy.
У 155 хворих з інфарктом міокарда правого шлуночка на фоні Q-інфаркту задньої стінки лівого шлуночка вивчалось прогностичне значення галектину-3 у розвитку серцево-судинних ускладнень при 30-місячному спостереженні. Рівень галектину-3 визначався на 2-гу добу гострого інфаркту та через 6 місяців (Platinun ELISA). Доведено прогностичне значення галектину-3 у розвитку нестабільної стенокардії, повторних інфарктів міокарда, гострих порушень мозкового кровообігу та серцево-судинної смерті протягом 30 місяців. Встановлено зв’язок між високою концентрацією галектину-3 через 6 місяців після інфаркту правого шлуночка і частотою комбінованої кінцевої точки.