New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men
Ivica Djuric,
Boris Dzudovic,
Bojana Subotic,
Jelena Dzudovic,
Jovan Matijasevic,
Marija Benic,
Sonja Salinger,
Irena Mitevska,
Ljiljana Kos,
Tamara Kovacevic-Preradovic,
Stefan Simovic,
Vladimir Miloradovic,
Tanja Savicic,
Bjanka Bozovic,
Nebojsa Bulatovic,
Srdjan Kafedzic,
Aleksandar N. Neskovic,
Nikola Kocev,
Jelena Marinković,
Slobodan Obradovic
Affiliations
Ivica Djuric
Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
Boris Dzudovic
Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia
Bojana Subotic
Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
Jelena Dzudovic
National Poison Control Center, Military Medical Academy, 11000 Belgrade, Serbia
Jovan Matijasevic
Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
Marija Benic
Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
Sonja Salinger
Clinic of Cardiology, Clinical Center Nis, University of Nis, 18000 Nis, Serbia
Irena Mitevska
Clinic of Cardiology, School of Medicine, University of Skopje, 1000 Skopje, North Macedonia
Ljiljana Kos
Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
Tamara Kovacevic-Preradovic
Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
Stefan Simovic
Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
Vladimir Miloradovic
Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
Tanja Savicic
Department for Internal Medicine, General Hospital Pancevo, 26000 Pancevo, Serbia
Bjanka Bozovic
Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
Nebojsa Bulatovic
Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
Srdjan Kafedzic
Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
Aleksandar N. Neskovic
Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
Nikola Kocev
Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
Jelena Marinković
Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
Slobodan Obradovic
Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
Background: Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. Methods: In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. Results: There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274–3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004–0.063); p = 0.013). Conclusion: The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.
