Article

Meta-analysis comparing reported frequency of atrial fibrillation after acute coronary syndromes in Asians versus whites.

Department of Cardiology, Cleveland Clinic Florida, Weston, Florida, USA.
The American Journal of Cardiology (Impact Factor: 3.21). 02/2008; 101(4):506-9. DOI: 10.1016/j.amjcard.2007.09.098
Source: PubMed

ABSTRACT The development of atrial fibrillation (AF) in cardiac patients is multifactorial, including not well defined genetic factors. To determine if Asian ethnicity is associated with the development of AF in patients with coronary disease, a meta-analysis was conducted of patient-level data from 7 prospective randomized clinical trials that prospectively collected information on the development of AF: 3 trials in patients with ST-elevation myocardial infarction (Global Use of Strategies to Open Occluded Coronary Arteries [GUSTO] I, GUSTO III, and GUSTO V), 3 trials in patients with non-ST-elevation acute coronary syndromes (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy [PURSUIT], Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis-II [IMPACT II], and Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network [PARAGON A]), and 1 trial in patients with both conditions (GUSTO IIb). A total of 94,785 patients were identified (93,050 white, 1,735 Asian). At baseline, Asian patients were younger; had lower body mass indexes; had a lower prevalence of female gender, previous angioplasty, and previous coronary artery bypass grafting; and had a greater prevalence of diabetes compared with white patients. The development of AF was lower in Asian than in white patients (4.7% vs 7.6%, p <0.001), while rates of ventricular tachycardia and fibrillation were similar in the 2 groups. In multivariate logistic regression analysis, Asian ethnicity was associated with significantly lower rates of AF (odds ratio 0.65, 95% confidence interval 0.50 to 0.84, p = 0.001) compared with white ethnicity. In conclusion, similar to previous studies showing a lower incidence of AF in non-Caucasian populations, Asians experiencing acute ischemic syndromes have a significantly lower frequency of AF compared with whites. Further study is needed to investigate the mechanisms and potential genetic underpinnings behind this association.

0 Bookmarks
 · 
89 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atrial fibrillation (AF) is more prevalent in Caucasians than in persons of other racial/ethnic groups. The purpose of this study was to examine the association between race/ethnicity and new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Data from all patients with no history of AF who underwent isolated CABG at our institution from 2000 through 2008 were analyzed. Univariate analyses of preoperative and perioperative variables were performed to identify predictors of POAF. Multivariate stepwise logistic regression was performed to determine independence. Propensity-score matching was used to assess racial/ethnic differences in POAF risk. Of the 5,823 patients (mean age 72 ± 11 years; 75.5% male) included in the study, 3,966 (68%) were Caucasian (mean age 65 ± 10 years; 77.9% male). The incidence of POAF was 28.9% (1,683/5,823) overall; 32.4% (1,287/3,966) in Caucasians and 21.3% (396/1,857) in non-Caucasians. Multivariate logistic regression revealed that Caucasian race/ethnicity independently predicted POAF (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.5-2.0; P <.0001). The propensity-matching analysis of 715 Caucasians and 715 non-Caucasians confirmed Caucasian race/ethnicity as an independent predictor of POAF (OR 1.7, 95% CI 1.3-2.2; P <.001). Other independent predictors were obesity (OR 1.4, 95% CI 1.0-2.0; P = .04), congestive heart failure (OR 1.8, 95% CI 1.3-2.6; P = .0002), and age 50-59 years (OR 3.7, 95% CI 1.7-8.3; P = .0006), with increasing risk for each additional increment of 10 years. Caucasians are at higher risk for POAF after isolated CABG than are persons of other races. Race probably is a surrogate for unrecognized variables such as genetic disparities among racial/ethnic groups.
    Heart rhythm: the official journal of the Heart Rhythm Society 10/2010; 7(10):1458-63. · 4.56 Impact Factor
  • Heart rhythm: the official journal of the Heart Rhythm Society 10/2010; 7(10):1464-5. · 4.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atrial fibrillation is a common arrhythmia. One of the important aspects of the management of atrial fibrillation is stroke prevention. Warfarin has been the longstanding anticoagulant used for stroke prevention in patients with atrial fibrillation. There are now three novel oral anticoagulants, which have been studied in randomized controlled trials and subsequently approved by the Federal Drug Administration for stroke prevention in patients with atrial fibrillation. Special patient populations, including renal insufficiency, elderly, prior stroke, and extreme body weights, were represented to varying degrees in the clinical trials of the novel oral anticoagulants. Furthermore, there is variation in the pharmacokinetics and pharmacodynamics of each anticoagulant, which affect the patient populations differently. Patients and clinicians are faced with the task of selecting among the available anticoagulants, and this review is designed to be a tool for clinical decision-making.
    Journal of Thrombosis and Thrombolysis 07/2013; · 1.99 Impact Factor

Full-text

View
33 Downloads
Available from
Jun 10, 2014