Urinary 11-dehydro-thromboxane B2 is associated with cardiovascular events and mortality in patients with atrial fibrillation.

Abstract

BACKGROUND:

Patients with nonvalvular atrial fibrillation (AF) show high residual cardiovascular (CV) risk despite oral anticoagulants. Urinary 11-dehydro-thromboxane B2 (TxB2) is associated with an increased risk of CV events (CVEs), but its predictive value in patients with anticoagulated AF is unknown.

METHODS:

A prospective single-center cohort study, including 837 patients with AF, was conducted. Mean time of follow-up was 30.0 months, yielding 2,062 person-years of observation. Urinary 11-dehydro-TxB2 was measured at baseline. The primary end point was the occurrence of a CVE including fatal/nonfatal myocardial infarction and ischemic stroke, transient ischemic attack, cardiac revascularization, and CV death.

RESULTS:

Mean age of patients was 73.1 years, and 43.6% were women. Median 11-dehydro-TxB2 levels were 100 (interquartile range 50-187) ng/mg of urinary creatinine. Overall, the anticoagulation control was adequate (63.9% of mean time in therapeutic range). A CVE occurred in 99 (11.8%) patients, and 55 were CV deaths. At baseline, 11-dehydro-TxB2 levels were higher in patients with a CVE compared with those without (186 [107-400] vs 98 [52-170], P < .001). An increased rate of CVEs (log-rank test, P < .001) and CV deaths (P < .001) was observed across tertiles of 11-dehydro-TxB2. Cardiovascular events were associated with age (hazard ratios [HR] 1.72 per 1 SD, 95% CI 1.33-2.21, P < .001), diabetes mellitus (HR 1.89, 95% CI 1.20-2.96, P = .005), heart failure (HR 1.60, 95% CI 1.01-2.54, P = .044), history of stroke/transient ischemic attack (HR 1.96, 95% CI 1.25-3.06, P = .003), and 11-dehydro-TxB2 (HR 1.64 per 1 SD, 95% CI 1.42-1.89, P < .001).

CONCLUSIONS:

Urinary 11-dehydro-TxB2 levels are associated with a residual risk of CVEs and CV mortality in patients with AF despite anticoagulant treatment.

• Authors: Daniele Pastori, Pasquale Pignatelli, Alessio Farcomeni, Roberto Cangemi, William R Hiatt, Simona Bartimoccia, Cristina Nocella, Tommasa Vicario, Tommaso Bucci, Roberto Carnevale, Gregory Y H Lip, Francesco Violi
• Journal: American heart journal (Am Heart J) Vol. 170 Issue 3 Pg. 490-7.e1 (Sep 2015) ISSN: 1097-6744 [Electronic] United States
• PMID: 26385032 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Thromboxane B2
• 11-dehydro-thromboxane B2

Topics

• Aged
• Atrial Fibrillation (mortality, urine)
• Biomarkers (urine)
• Death, Sudden, Cardiac (epidemiology)
• Enzyme-Linked Immunosorbent Assay
• Female
• Follow-Up Studies
• Humans
• Incidence
• Italy (epidemiology)
• Male
• Myocardial Infarction (epidemiology)
• Prospective Studies
• Risk Assessment
• Stroke (epidemiology)
• Survival Rate (trends)
• Thromboxane B2 (analogs & derivatives, urine)
• Time Factors