Aims Atrial fibrillation and renal dysfunction are associated with increased cardiovascular risk. We examined the association between renal function and incident ischaemic stroke or myocardial infarction in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs). Methods and results This study was conducted using a large health record database. Included were 19 713 patients with first time diagnosis of non-valvular atrial fibrillation treated with DOACs between 2010 and 2018. Patients were categorized into four groups according to the estimated glomerular filtration rate (eGFR) (<30, 30–59, 60–89, and ≥90 mL/min/1.73 m2). Ischaemic stroke and acute myocardial infarction rates were compared between the groups. During 55 086 person-years of follow-up, there were 2295 (11.6%) cases of ischaemic stroke and 1158 (5.9%) cases of acute myocardial infarction. There was a significant inverse association between eGFR and the risk of myocardial infarction. A multivariate analysis using the group with eGFR ≥90 mL/min/1.73 m2 as a reference demonstrated an increased risk of myocardial infarction with lower eGFR [hazard ratio (HR) = 1.2 95% confidence interval (CI) 0.9–1.4, HR = 1.4, 95% CI 1.2–1.7, and HR = 2.5, 95% CI 1.8–3.4 for patients with eGFR 60–89, 30–59, and <30 mL/min/1.73 m2, respectively, P < 0.001]. Each 10 mL decrease in eGFR was associated with an 8% increase in the risk of myocardial infarction. There was no association between eGFR and the risk of ischaemic stroke (HR = 0.9 95% CI 0.8–1.1, HR = 0.93, 95% CI 0.8–1.1, and HR = 1.1, 95% CI 0.8–1.4 for patients with eGFR 60–89, 30–59, and <30 mL/min/1.73 m2, respectively, P = 0.325). Conclusions Renal dysfunction is associated with an increased risk of myocardial infarction but not of ischaemic stroke among patients with atrial fibrillation treated with DOACs.

中文翻译：

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非瓣膜性房颤患者的肾功能和预后

目的 心房颤动和肾功能不全与心血管风险增加有关。我们检查了接受直接口服抗凝剂 (DOAC) 治疗的心房颤动患者的肾功能与缺血性卒中或心肌梗死之间的关系。方法和结果 本研究使用大型健康记录数据库进行。包括 2010 年至 2018 年期间首次诊断为非瓣膜性房颤的 19713 名患者。根据估计的肾小球滤过率 (eGFR) (<30, 30–59, 60–)，将患者分为四组。 89 和≥90 毫升/分钟/1.73 平方米）。比较两组间缺血性卒中和急性心肌梗死的发生率。在 55086 人年的随访中，有 2295 例（11.6%）缺血性卒中病例和 1158 例（5. 9%) 急性心肌梗塞病例。eGFR 与心肌梗死风险之间存在显着负相关。使用 eGFR ≥ 90 mL/min/1.73 m2 的组作为参考的多变量分析表明，eGFR 较低的心肌梗死风险增加 [风险比 (HR) = 1.2 95% 置信区间 (CI) 0.9–1.4, HR =对于 eGFR 60-89、30-59 和 <30 mL/min/1.73 m2 的患者，分别为 1.4、95% CI 1.2-1.7 和 HR = 2.5、95% CI 1.8-3.4，P < 0.001]。eGFR 每降低 10 mL，心肌梗死风险就会增加 8%。eGFR 与缺血性卒中风险之间没有关联（对于 eGFR 60 的患者，HR = 0.9 95% CI 0.8-1.1，HR = 0.93，95% CI 0.8-1.1，HR = 1.1，95% CI 0.8-1.4分别为 –89、30–59 和 <30 mL/min/1.73 m2，P = 0.325）。