Effectiveness and Safety of Anticoagulation in Nonvalvular Atrial Fibrillation Patients with a Non-sex-related CHA2DS2-VA Score of 0 or 1

배경: 비판막성 심방세동 환자에서 뇌졸중 예측 점수인 CHA2DS2-VASc score 에서 성별 인자를 제외한 CHA2DS2-VA score 0점 혹은 1점인 환자들에게서 항응고 치료의 효과와 안전성에 대한 임상 연구들이 부족한 실정으로 이런 환자들에게서 항응고 치료의 효과와 안전성을 조사해볼 필요가 있다. 방법: 서울아산병원 전자의무기록 시스템을 이용하여 1998년부터 2017년까지 자료를 분석하여 총 5,567명의 CHA2DS2-VA score 0점인 비판막성 심방세동 환자와 총 5,039 명의 CHA2DS2-VA score 1점인 환자들을 추출하였다. 환자들은 와파린이나 새로운 항응고제 처방을 받은 치료군과 처방을 받지 않은 비치료군으로 나누었으며 두 군간의 뇌졸중, 전신 색전증, 주요 출혈의 발생 정도를 비교하였다. 결과: 17.3 개월의 중간 추적 관찰 기간 동안 뇌졸중 혹은 전신 색전증의 위험을 보자면 CHA2DS2-VA score 0점 환자군에서는 항응고제 치료군과 비치료군은 큰 차이가 없었으며 (위험비, 1.11; 95% 신뢰구간, 0.56–2.17), 1점인 환자군에서는 치료군이 비치료군에 비해 위험율이 낮은 경향을 보였으나 통계적으로 의미는 없었다 (위험비, 0.58; 95% 신뢰구간, 0.31–1.09). 안전성 면에서는 항응고 치료가 CHA2DS2-VA score 0점 환자군에서는 비치료군에 비해 주요 출혈은 증가하는 경향을 보였으나 통계학적 의미는 없었으며 (위험비, 1.43; 95% 신뢰구간, 0.61–3.34), CHA2DS2-VA score 1점 환자군에서는 두 군간의 발생율은 비슷하였다 (위험비, 0.95; 95% 신뢰구간, 0.50–1.90). CHA2DS2-VA score 1점 환자군 중 연령 점수 (65–74 세)를 가지는 군에서는 항응고 치료군이 비치료군에 비해 뇌졸중 혹은 전신 색전증의 발생율을 의미 있게 낮추었다 (위험비, 0.42; 95% 신뢰구간, 0.18–0.98, P value = 0.046). 결론: 성별 인자를 제외한 CHA2DS2-VA score 0 혹은 1점인 비판막성 심방세동 환자들에서는 항응고 치료가 비치료군에 비해 주요 출혈의 증가 없이 뇌졸중 혹은 전신 색전증을 낮추는 경향을 보여 주었다. CHA2DS2-VA score 1점 환자 중 연령 점수 (65–74 세)를 가지는 군에서는 항응고 치료가 뇌졸중 혹은 전신 색전증의 발생을 의미 있게 낮추었다. |BACKGROUND: There are limited real-world data on the effectiveness and safety of anticoagulation in nonvalvular atrial fibrillation (NVAF) patients with a non-sex-related CHA2DS2-VA score of 0 or 1. We aimed to compare the effectiveness and safety outcomes of anticoagulant treatment and no treatment in this population. METHODS: Using datasets form the Asan BiomedicaL research Environment database (between 1998 and 2017), this study comprised 5,567 NVAF patients with a non-sex-related CHA2DS2-VA score of 0 and 5,039 with a score of 1. Study patients were divided into treatment or control groups according to prescription of warfarin or non-vitamin K oral anticoagulants. Primary outcomes included stroke or systemic embolism and major bleeding. RESULTS: During the median follow-up of 17.3 months, anticoagulant treatment was associated with a similar risk of stroke or systemic embolism in comparison with control (hazard ratio [HR], 1.11; 95% confidence intervals [CI], 0.56–2.17) in patients with a score of 0, and with a non-significantly lower risk (HR, 0.58; 95% CI, 0.31–1.09) in those with a score of 1. Regarding safety outcomes, anticoagulant treatment had a non-significantly higher risk of major bleeding in comparison with control (HR, 1.43; 95% CI, 0.61–3.34) in patients with a score of 0, but the risk was similar (HR, 0.95; 95% CI, 0.50–1.90) in those with a score of 1. Among patients aged 65–74 years, anticoagulant treatment was associated with a significantly lower risk of stroke or systemic embolism in comparison with control (HR, 0.42; 95% CI, 0.18–0.98, P value = 0.046). CONCLUSION: In an NVAF patients with a non-sex-related CHA2DS2-VA score of 0 or 1, anticoagulant treatment was associated with a non-significantly lower risk of stroke or systemic embolism in comparison with control, with no effect on major bleeding. Among patients with a non-sex-related CHA2DS2-VA score of 1, anticoagulant treatment was associated with a significant reduction of the incidence of stroke and systemic embolism versus control in patients aged 65–74 years.Docto

Comparison of new implantation of cardiac implantable electronic device between tertiary and non-tertiary hospitals: a Korean nationwide study

This study compared the characteristics and mortality of new implantation of cardiac implantable electronic device (CIED) between tertiary and non-tertiary hospitals. From national health insurance claims data in Korea, 17,655 patients, who underwent first and new implantation of CIED between 2013 and 2017, were enrolled. Patients were categorized into the tertiary hospital group (n=11,560) and non-tertiary hospital group (n=6095). Clinical outcomes including in-hospital death and all-cause death were compared between the two groups using propensity-score matched analysis. Patients in non-tertiary hospitals were older and had more comorbidities than those in tertiary hospitals. The study population had a mean follow-up of 2.1 +/- 1.2 years. In the propensity-score matched permanent pacemaker group (n=5076 pairs), the incidence of in-hospital death (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.43-1.32, p=0.33) and all-cause death (hazard ratio [HR]: 0.92, 95% CI 0.81-1.05, p=0.24) were not significantly different between tertiary and non-tertiary hospitals. These findings were consistently observed in the propensity-score matched implantable cardioverter-defibrillator group (n=992 pairs, OR for in-hospital death: 1.76, 95% CI 0.51-6.02, p=0.37; HR for all-cause death: 0.95, 95% CI 0.72-1.24, p=0.70). In patients undergoing first and new implantation of CIED in Korea, mortality was not different between tertiary and non-tertiary hospitals

Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696-0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775-0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs