Renal Dysfunction as a Predictor of Stroke and Systemic Embolism in Patients With Nonvalvular Atrial Fibrillation

DOI Web Site 被引用文献25件
  • Jonathan P. Piccini
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Susanna R. Stevens
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • YuChiao Chang
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Daniel E. Singer
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Yuliya Lokhnygina
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Alan S. Go
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Manesh R. Patel
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Kenneth W. Mahaffey
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Jonathan L. Halperin
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Günter Breithardt
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Graeme J. Hankey
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Werner Hacke
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Richard C. Becker
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Christopher C. Nessel
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Keith A.A. Fox
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...
  • Robert M. Califf
    From the Duke Clinical Research Institute (J.P.P., S.R.S., Y.L., M.R.P., K.W.M., R.C.B.) and Duke Translational Medicine Institute (R.M.C.), Duke University Medical Center, Durham, NC; Massachusetts General Hospital and Harvard Medical School, Boston, MA (Y.C., D.E.S.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); Mount Sinai Medical Center, New York, NY (J.L.H.); Hospital of the University of Münster, Münster, Germany (G.B.); Royal Perth Hospital, Perth, Western Australia,...

書誌事項

タイトル別名
  • Validation of the R <sub>2</sub> CHADS <sub>2</sub> Index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) Study Cohorts

抄録

<jats:sec> <jats:title>Background—</jats:title> <jats:p>We sought to define the factors associated with the occurrence of stroke and systemic embolism in a large, international atrial fibrillation (AF) trial.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> In ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation), 14 264 patients with nonvalvular AF and creatinine clearance ≥30 mL/min were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards modeling was used to identify factors at randomization independently associated with the occurrence of stroke or non–central nervous system embolism based on intention-to-treat analysis. A risk score was developed in ROCKET AF and validated in ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation), an independent AF patient cohort. Over a median follow-up of 1.94 years, 575 patients (4.0%) experienced primary end-point events. Reduced creatinine clearance was a strong, independent predictor of stroke and systemic embolism, second only to prior stroke or transient ischemic attack. Additional factors associated with stroke and systemic embolism included elevated diastolic blood pressure and heart rate, as well as vascular disease of the heart and limbs (C-index 0.635). A model that included creatinine clearance (R <jats:sub>2</jats:sub> CHADS <jats:sub>2</jats:sub> ) improved net reclassification index by 6.2% compared with CHA <jats:sub>2</jats:sub> DS <jats:sub>2</jats:sub> VASc (C statistic=0.578) and by 8.2% compared with CHADS <jats:sub>2</jats:sub> (C statistic=0.575). The inclusion of creatinine clearance <60 mL/min and prior stroke or transient ischemic attack in a model with no other covariates led to a C statistic of 0.590.Validation of R <jats:sub>2</jats:sub> CHADS <jats:sub>2</jats:sub> in an external, separate population improved net reclassification index by 17.4% (95% confidence interval, 12.1%–22.5%) relative to CHADS <jats:sub>2</jats:sub> . </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>In patients with nonvalvular AF at moderate to high risk of stroke, impaired renal function is a potent predictor of stroke and systemic embolism. Stroke risk stratification in patients with AF should include renal function.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Trial Registration—</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov">http://www.ClinicalTrials.gov</jats:ext-link> . Unique identifier: NCT00403767. </jats:p> </jats:sec>

収録刊行物

  • Circulation

    Circulation 127 (2), 224-232, 2013-01-15

    Ovid Technologies (Wolters Kluwer Health)

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