Author + information
- Alice Wang,
- John Alexander,
- Hillary Mulder,
- Renato Lopes,
- Petr Jansky,
- Basil Lewis,
- Bernard Gersh,
- Alvaro Avezum,
- Michael Hanna,
- Claes Held,
- Lars Wallentin,
- Christopher Granger and
- Dragos Vinereanu
Background: Using data from ARISTOTLE, we assessed the relationship between valvular heart disease (VHD) and clinical outcomes and the treatment effect of apixaban vs. warfarin.
Methods: Patients were included only if their status for all VHD subcategories was known (n=14,793). VHD was defined as moderate or severe mitral regurgitation (MR; n=3382 [23%]), aortic regurgitation (AR; n=842 [6%]), or aortic stenosis (AS; n=324 [2%]). Baseline characteristics, efficacy and safety outcomes were compared between each VHD subcategory and no/mild VHD. Treatment effect on the prespecified outcomes for each VHD subcategory was assessed by an adjusted model.
Results: Despite increased CHADS2, vascular disease, and female sex, patients with MR or AR did not have increased rates (events/100 patient-years) of any of the efficacy and safety outcomes, whereas patients with AS did have higher rates of stroke or systemic embolism, all-cause death, and major and intracranial bleeding. Patients with AS vs. MR or AR were older, with more diabetes and hypertension. The efficacy and safety benefits of apixaban vs. warfarin were consistent regardless of presence of VHD for each subcategory.
Conclusions: In anticoagulated patients with AF, valvular regurgitations (MR and AR) did not increase the risk of clinical events, whereas AS still carried a higher risk of stroke or systemic embolism, death, and major bleeding. There was no evidence of a differential effect of apixaban over warfarin in patients with any VHD subcategory.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Miscellaneous and Surgical Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1236-090
- 2017 American College of Cardiology Foundation