Higher premature atrial complex burden from the Holter examination predicts poor cardiovascular outcome

Ting-Chun Huang,Pei-Fang Su,Ping-Yen Liu,Po-Tseng Lee,Mu-Shiang Huang

doi:10.1038/s41598-021-91800-4

Abstract

Premature atrial complexes (PACs) have been suggested to increase the risk of adverse events. The distribution of PAC burden and its dose–response effects on all-cause mortality and cardiovascular death had not been elucidated clearly. We analyzed 15,893 patients in a medical referral center from July 1st, 2011, to December 31st, 2018. Multivariate regression driven by ln PAC (beats per 24 h plus 1) or quartiles of PAC burden were examined. Older group had higher PAC burden than younger group (p for trend < 0.001), and both genders shared similar PACs distribution. In Cox model, ln PAC remained an independent risk factor for all-cause mortality (hazard ratio (HR) = 1.09 per ln PAC increase, 95% CI = 1.06‒1.12, p < 0.001). PACs were a significant risk factor in cause-specific model (HR = 1.13, 95% CI = 1.05‒1.22, p = 0.001) or sub-distribution model (HR = 1.12, 95% CI = 1.04‒1.21, p = 0.004). In ordinal PAC model, 4th quartile group had significantly higher risk of all-cause mortality than those in 1st quartile group (HR = 1.47, 95% CI = 1.13‒1.94, p = 0.005), but no difference in cardiovascular death were found in competing risk analysis. In subgroup analysis, the risk of high PAC burden was consistently higher than in low-burden group across pre-specified subgroups. In conclusion, PAC burden has a dose response effect on all-cause mortality and cardiovascular death.

Highlights

Premature atrial complexes (PACs) have been suggested to increase the risk of adverse events
In the latest meta-analysis 9, frequent PACs were associated with atrial fibrillation (AF) [hazard ratio (HR) 2.96, 95% confidence interval (CI) 2.33‒3.76], first stroke (HR 2.54, 95% CI 1.68‒3.83), and all-cause mortality (HR 2.14, 95% CI 1.94‒2.37)
We found that ln PAC could predict all-cause mortality (odds ratio (OR) = 1.27, 95% CI = 1.24‒1.31, p < 0.001)

Summary

Introduction

Premature atrial complexes (PACs) have been suggested to increase the risk of adverse events. The distribution of PAC burden and its dose–response effects on all-cause mortality and cardiovascular death had not been elucidated clearly. In ordinal PAC model, 4th quartile group had significantly higher risk of all-cause mortality than those in 1st quartile group (HR = 1.47, 95% CI = 1.13‒1.94, p = 0.005), but no difference in cardiovascular death were found in competing risk analysis. PACs were reported to be a risk factor for all-cause m ortality[9], the dose–response effects on all-cause mortality and cardiovascular death had not been fully elucidated. We enrolled a hospital-based East Asian cohort of more than 20,000 patients who had undergone 24-h Holter monitoring to exhibit the distribution of PACs, and collected all relevant clinical information, to investigate the effects of PAC burden on all-cause mortality by different models and cardiovascular death by competing risk model

Methods

Results

Conclusion