Stroke Clinical Trial
— AFAFOfficial title:
Atrial Fibrillation After CABG and PCI
NCT number | NCT04307225 |
Other study ID # | 2015-08-3 |
Secondary ID | |
Status | Completed |
Phase | |
First received | |
Last updated | |
Start date | August 2015 |
Est. completion date | January 2022 |
Verified date | April 2022 |
Source | Region Örebro County |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational [Patient Registry] |
Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice and is associated with an increased risk of stroke, heart failure and death. Oral anticoagulation (OAC) is the only treatment so far being able to reduce mortality in AF patients, despite new antiarrhythmic drugs and ablation techniques. Postoperative AF affects one-third of patients undergoing aortocoronary bypass surgery (CABG). Postoperative AF is associated with an increased 30-day mortality compared to patients who are in sinus rhythm during the hospital stay. . The risk of future AF is increased in patients with postoperative AF, and one-fourth of patients with an episode of postoperative AF develop later AF. At six years follow-up, 9.1% of patients with postoperative AF have had a lethal or non-lethal episode of ischemic stroke, compared to 3.0% of patients in SR (p=.002). Atrial fibrillation is a common complication of myocardial infarction, with an incidence of new-onset AF between 5-20%. New-onset AF occurs postoperatively in 5-6% of patients undergoing acute percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), and is marker of adverse outcomes. However, studies of heart rhythm beyond the post procedural period following PCI are lacking. About one third of all AF is asymptomatic, silent and often paroxysmal. The risk of stroke seems to be the same for silent AF as for those with symptomatic AF. In trials comparing PCI and CABG, there is a consistent difference in stroke rate. Several studies have shown an increased risk of late cardiovascular death and ischemic stroke in postoperative AF patients, and the difference in stroke rate between PCI and CABG may be explained by unprotected episodes of AF after discharge. The investigators therefore hypothesize that patients undergoing CABG have an increased risk of silent AF postoperatively compared to patients undergoing PCI and that this difference may explain some of the differences in stroke rate between PCI and CABG patients.
Status | Completed |
Enrollment | 250 |
Est. completion date | January 2022 |
Est. primary completion date | December 2021 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - NSTEMI - Stable or unstable angina requiring revascularization therapy. - No prior hitory of Atrial Fibrillation Exclusion Criteria: - Previous History of Atrial Fibrillation. - Any condition that contraindicates oral anticoagulation treatment |
Country | Name | City | State |
---|---|---|---|
Sweden | Department of Cardiothoracic and Vascular surgery, Örebro University Hospital | Örebro |
Lead Sponsor | Collaborator |
---|---|
Region Örebro County | Danderyd Hospital, University Hospital, Linkoeping |
Sweden,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in Incidence of Postoperative/postinterventional Atrial Fibrillation | through study completion, an average of 2 years | ||
Primary | Oral Anticoagulation treatment to those who develope Atrial fibrillation | Oral Anticoagulation treatment to those who develope Atrial fibrillation, according to individual risk assessment by CHA2D2VASC score (Congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, sex - score, min 0 Points (good), max 9 Points):
Congestive heart failure 1p Uncontrolled hypertension 1p Age = 75 years 2p Age 65-74 years 1p Diabetes 1p Stroke / TIA / Thromboembolism 2p Vascular disease 1p Female gender 1p 2p or more warrants oral anticoagulation, if no contraindication given individual predictive bleeding assessment. |
During 2 years of follow-up | |
Secondary | Predictors of postoperative atrial fibrillation | Predictive markers for development of postoperative/postinterventional Atrial Fibrillation | 1 month, 3 months, 12 months and 24 months postoperatively |
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