Arrhythmias & electrophysiologySecondary analysis
Risk of Stroke or Systemic Embolism According to Baseline Frequency and Duration of Subclinical Atrial Fibrillation: Insights From the ARTESiA Trial
- Secondary analysis of the ARTESiA randomised trial
- retrospective cohort study
- Cox regression adjusted for CHA2DS2-VASc score and treatment allocation
Authors' conclusion
In ARTESiA, baseline SCAF frequency and longest episode duration were not associated with risk of stroke or systemic embolism and did not modify the effect of apixaban on reduction of stroke or systemic embolism.
Study context
- Population
- Patients with device-detected subclinical AF (subclinical atrial fibrillation (SCAF)) in the ARTESiA trial (apixaban vs aspirin)3,986 with complete baseline SCAF data
- Participants
- 2,542 / 741 / 1,030 / 1,421 / 832
- Comparison
- SCAF episode frequency and longest episode duration as predictors of stroke risk and apixaban treatment effect
- 1 to 5 episodesn = 2,542reference
- ≥6 episodesn = 741
- <1 hourn = 1,030reference
- 1 to <6 hoursn = 1,421
- >6 hoursn = 832
- Primary endpoint
- Stroke or systemic embolism
Primary result
As reported in the abstract
Stroke or systemic embolism by baseline SCAF frequency and longest episode duration
Adjusted hazard ratio (95% CI)
≥6 episodes vs 1 to 5 episodes
0.89(0.59–1.34)
1 to <6 hours vs <1 hour
1.27(0.85–1.90)
>6 hours vs <1 hour
1.02(0.63–1.66)
- SCAF frequency did not modify the reduction in stroke or systemic embolism with apixaban
- P for interaction = 0.1
- SCAF duration did not modify the reduction in stroke or systemic embolism with apixaban
- P for trend = 0.1
Further findings
per patient-year
| Outcome | No recent episode | ≥1 episode | adjusted HR (95% CI) | |
|---|---|---|---|---|
| Stroke or systemic embolism: previous SCAF but no episode ≥6 min in prior 6 months vs ≥1 episode (exploratory) · exploratory analysis | 0.5% | 1.1% | 0.48 (0.27–0.85) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- Stroke or systemic embolism: previous SCAF but no episode ≥6 min in prior 6 months vs ≥1 episode (exploratory): 703 (17.6%) no recent episode; 3283 (82.4%) ≥1 episode
Original publication
Risk of Stroke or Systemic Embolism According to Baseline Frequency and Duration of Subclinical Atrial Fibrillation: Insights From the ARTESiA Trial. Circulation. Published 4 September 2024. doi:10.1161/circulationaha.124.069903
Summarised from the published abstract; every number is checked against it