Comprehensive clinical descriptions of SEEs, including anatomic distribution and diagnostic methodology, provide a detailed understanding of the different arterial beds commonly affected by peripheral embolism in AF. Careful end point ascertainment and independent readjudication of events with prespecified diagnostic criteria enhance the validity of the results. Collation of readily available, ethnically diverse patient cohorts yielded the largest reported assessment of AF-related SEEs to date. This study has a number of strengths that distinguish it from previous literature. SEEs were associated with ≈4-fold increased risk of long-term mortality, in comparison with a ≈7-fold increased risk of mortality associated with ischemic stroke. SEEs were associated with similar and significant 30-day mortality in comparison with stroke alone (24% versus 25%). Most patients underwent an invasive procedure as part of their clinical management. Anatomically, ≈60% of SEEs involved the lower extremities, whereas ≈30% occurred in the visceral-mesenteric system, and only 11% occurred in the upper extremities. The incidence of SEEs (0.24/100 person-years) was lower than of cerebral embolism (1.92/100 person-years) and comprised 12% of clinically recognized thromboembolic events. Overall, 221 SEEs occurred in 219 individuals during a mean follow-up of 2.4 years. †Dabigatran dose was either 110 mg or 150 mg. They then examined the risks of both 30-day and long-term morbidity in relation to SEEs. A SEE was defined by both clinical and objective evidence of the sudden loss of end-organ perfusion. 8 – 11 The investigators readjudicated suspected SEEs by using a harmonized classification scheme. They retrospectively pooled data from 4 published randomized trials of antiplatelet or anticoagulant therapy in AF patients encompassing a total of 37 973 individuals ( Table). In this issue of Circulation, Bekwelem and colleagues 7 improve our understanding of the epidemiology and prognostic implications of systemic embolism in AF. 3 In contrast to the well-characterized risk and sequelae of cerebral embolism, much less is known regarding the clinical risk factors and outcomes associated with systemic embolic events (SEEs) in AF. 2 Although embolism of cardiac thrombi can involve any vascular territory, there has been a historical focus on cerebral embolism, an outcome associated with substantial disability and mortality. 1 The pathogenesis of intracardiac thrombus formation in AF is linked to each component of Virchow’s triad including atrial stasis, endothelial dysfunction, and a systemic hypercoagulable state. Thromboembolism is central to atrial fibrillation (AF)–related morbidity. ![]()
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