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Internal and Emergency Medicine

, Volume 13, Issue 5, pp 651–660 | Cite as

Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study

  • Valeria Raparelli
  • Daniele Pastori
  • Serena Francesca Pignataro
  • Anna Rita Vestri
  • Pasquale Pignatelli
  • Roberto Cangemi
  • Marco Proietti
  • Giovanni Davì
  • William Robert Hiatt
  • Gregory Yoke Hong Lip
  • Gino Roberto Corazza
  • Francesco Perticone
  • Francesco Violi
  • Stefania Basili
  • ARAPACIS Study Collaborators
IM - ORIGINAL
  • 318 Downloads

Abstract

Chronic obstructive pulmonary disease (COPD) increases the risk of mortality in non-valvular atrial fibrillation (NVAF) patients. Data on the relationship of COPD to major cardiovascular events (MACE) in AF have not been defined. The aim of the study is to assess the predictive value of COPD on incident MACE in NVAF patients over a 3-year follow-up. In the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study (ARAPACIS) cohort, we evaluate the impact of COPD on the following clinical endpoints: MACE (including vascular death, fatal/non-fatal MI and stroke/TIA), cardiovascular (CV) death and all-cause mortality. Among 2027 NVAF patients, patients with COPD (9%) are more commonly male, elderly and at higher thromboembolic risk. During a median 36.0 months follow-up, 186 patients experienced MACE: vascular death (n = 72), MI (n = 57), stroke/TIA (n = 57). All major outcomes (including stroke/TIA, MI, vascular death, and all-cause death) are centrally adjudicated. Kaplan–Meier curves show that NVAF patients with COPD are at higher risk for MACE (p < 0.001), CV death (p < 0.001) and all-cause death (p < 0.001). On Cox proportional hazard analysis, COPD is an independent predictor of MACE (Hazard ratio [HR] 1.77, 95% Confidence Intervals [CI] 1.20–2.61; p = 0.004), CV death (HR 2.73, 95% CI 1.76–4.23; p < 0.0001) and all-cause death (HR 2.16, 95% CI 1.48–3.16; p < 0.0001). COPD is an independent predictor of MACE, CV death and all-cause death during a long-term follow-up of NVAF patients.

Keywords

Chronic obstructive pulmonary disease Atrial fibrillation Cardiovascular mortality Major cardiovascular events 

Notes

Acknowledgements

Dr. Hiatt reports grants from Bayer, Janssen and AstraZeneca, outside the submitted work. ARAPACIS STUDY Collaborators Alessandri C., Serviddio G., Palange P., Greco E., Bruno G., Averna M., Giammanco A., Sposito P., De Cristofaro R., Carulli L., De Gennaro L., Pellegrini E. Cominacini L., Mozzini C., Pasini A.F.; Sprovieri M., Spagnuolo V., Cerqua G., Cerasola G., Mulé G., Barbagallo M., Lo Sciuto S., Monteverde A., Saitta A., Lo Gullo A., Malatino L., Cilia C., Terranova V., Pisano M., Pinto A., Di Raimondo D., Tuttolomondo A., Conigliaro R., Signorelli S., De Palma D., Galderisi M., Cudemo G., Galletti F., Fazio V., De Luca N., Meccariello A., Caputo D., De Donato M. T., Iannuzi A., Bresciani A., Giunta R., Utili R., Iorio V., Adinolfi L.E., Sellitto C., Iuliano N., Bellis P., Tirelli P., Sacerdoti D., Vanni D., Iuliano L., Ciacciarelli M., Pacelli A., Palazzuoli A., Cacciafesta M., Gueli N., Lo Iacono C., Brusco S., Verrusio W., Nobili L., Tarquinio N., Pellegrini F., Vincentelli G.M., Ravallese F., Santini C., Letizia C., Petramala L., Zinnamosca L., Minisola S., Cilli M., Colangelo L., Falaschi P., Martocchia A., Pastore F., Bertazzoni G., Attalla El Halabieh E., Paradiso M., Lizzi E.M., Timmi S., Battisti P., Cerci S., Ciavolella M., Di Veroli C., Malci F., De Ciocchis A., Abate D., Castellino P., Zanoli L., Fidone F., Mannarino E., Pasqualini L., Oliverio G., Pende A., Artom N., Ricchio R., Fimognari F.L., Alletto M., Messina S., Sesti G., Arturi F., Succurro E, Fiorentino T.V., Pedace E., Scarpino P.E., Carullo G., Maio R., Sciacqua A., Frugiuele P., Spagnuolo V., Battaglia G., Atzori S., Delitala G., Angelucci E., Sestili S., Traisci G., De Feudis L., Di Michele D., Fava A., Balsano C., De Ciantis P., Desideri G., Camerota A., Mezzetti M., Gresele P., Vedovati C., Fierro T., Puccetti L., Bertolotti M., Mussi C., Boddi M., Savino A., Contri S., Degl’Innocenti G., Saller A., Fabris F., Pesavento R., Filippi L., Vedovetto V., Puato M., Fabris F., Treleani M., De Luca E., De Zaiacomo F., Giantin V., Semplicini A., Minuz P., Romano S., Fantin F., Manica A., Stockner I., Pattis P., Gutmann B., Catena C., Colussi G., Sechi L.A., Annoni G., Bruni A.A., Castagna A., Spinelli D., Miceli E., Padula D., Schinco G., Spreafico S., Secchi B., Vanoli M., Casella G., Pulixi E.A., Sansone L., Serra M.G., Longo S., Antonaci S., Belfiore A., Frualdo M., Palasciano G., Ricci L., Ventrella F., Bianco C., Santovito D., Cipollone F., Nicolai S., Salvati F., Rini G. B., Scozzari F., Muiesan M.L., Salvetti M., Bazza A., Picardi A., Vespasiani-Gentilucci U., De Vincentis A., Cosio P., Terzolo M., Madaffari B., Parasporo B., Fenoglio L., Bracco C., Melchio R., Gentili T., Salvi A., Nitti C., Gabrielli A., Martino G.P., Capucci A., Brambatti M., Sparagna A., Tirotta D., Andreozzi P., Ettorre E., Viscogliosi G., Servello A., Musumeci M., Delfino M., Giorgi A., Glorioso N., Melis G., Marras G., Matta M., Sacco A., Stellitano E., Scordo A., Russo F., Caruso A.A., Porreca E., Tana M., Ferri C., Cheli P., Portincasa P., Muscianisi G., Giordani S., Stanghellini V., Sabbà C., Mancuso G., Bartone M., Calipari D., Arcidiacono G., Bellanuova I., Ferraro M., Marigliano G., Cozzolino D., Lampitella A., Acri V., Galasso D., Mazzei F., Buratti A., Galasso S., Porta M., Brizzi M.F., Fattorini A., Sampietro F., D’Angelo A., Manfredini R., Pala M., Fabbian F., Moroni C., Valente L., Lopreiato F., Parente F., Granata M., Moia M., Braham S., Rossi M., Pesce M., Gentile A., Catozzo V., Baciarello G., Cosimati A., Ageno W., Rancan E., Guasti L., Ciccaglioni A., Negri S., Polselli M., Prisco D., Marcucci R., Ferro D., Perri L.,, Cangemi R., Saliola M., Del Ben M., Angelico F., Baratta F., Migliacci R., Porciello G., Corrao S. Data entry and Safety Monitoring Board: Proietti M., Raparelli V., Napoleone L., Talerico G., Amoroso D., Romiti G.F., Ruscio E., Toriello F., Sperduti N., Todisco T., Di Tanna G., Sacchetti M.L., Puddu P.E., Farcomeni A. Simi Young Internists Group: Anzaldi M., Bazzini C., Bianchi P.I., Boari B., Bracco C., Buonauro A., Buttà C., Buzzetti E., Calabria S., Capeci W., Caradio F., Carleo P., Carrabba M.D., Castorani L., Cecchetto L., Cicco S., Cimini C., Colombo B.M., De Giorgi A., De Vuono S., Del Corso L., Denegri A., Di Giosia P., Durante Mangoni E., Falsetti L., Forgione A., Giorgini P., Grassi D., Grembiale A., Hijazi D., Iamele L., Lorusso G., Marchese A., Marra A.M., Masala M., Miceli G., Montebianco Abenavoli L., Murgia G., Naccarato P., Padula D., Pattoneri P., Perego F., Pesce P., Piano S., Pinna M., Pinto D., Pretti V., Pucci G., Salinaro F., Salzano A., Santilli F., Scarpini F., Scicali R., Sirico D., Suppressa P., Talia M., Tassone E.J., Torres D., Vazzana N., Vecchio C.R., Vidili G., Vitale F., Zaccone V.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in this study involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in this study.

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Copyright information

© SIMI 2018

Authors and Affiliations

  • Valeria Raparelli
    • 1
  • Daniele Pastori
    • 1
  • Serena Francesca Pignataro
    • 1
  • Anna Rita Vestri
    • 2
  • Pasquale Pignatelli
    • 1
  • Roberto Cangemi
    • 1
  • Marco Proietti
    • 3
  • Giovanni Davì
    • 4
  • William Robert Hiatt
    • 5
  • Gregory Yoke Hong Lip
    • 3
  • Gino Roberto Corazza
    • 6
  • Francesco Perticone
    • 7
  • Francesco Violi
    • 1
  • Stefania Basili
    • 1
  • ARAPACIS Study Collaborators
  1. 1.Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis CenterSapienza University of RomeRomeItaly
  2. 2.Department of Public Health and Infections DiseaseSapienza University of RomeRomeItaly
  3. 3.University of Birmingham Institute of Cardiovascular Sciences, City HospitalBirminghamUK
  4. 4.Department of Medicine and AgingUniversity of Chieti “G. d’AnnunzioChietiItaly
  5. 5.Division of CardiologyUniversity of Colorado School of Medicine and CPC Clinical ResearchAuroraUSA
  6. 6.First Department of Internal Medicine, Fondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
  7. 7.Department of Medical and Surgical SciencesUniversity Magna Græcia of CatanzaroCatanzaroItaly

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