Risk of Embolic Events in Patients with Chagasic Cardiomyopathy and Atrial Fibrillation Despite Antithrombotic Therapy: Is Anticoagulation Enough?

Background: Chagasic cardiomyopathy (CC) differs from other heart failure causes in multiple aspects, highlighting the risk of systemic embolisms.However, few studies have evaluated the risk of embolic events in anticoagulated patients with CC compared with other cardiomyopathies.Objective: We aimed to analyze the incidence of systemic embolisms in a cohort of anticoagulated patients diagnosed with atrial fibrillation (AF) with and without CC.Methods: A retrospective cohort study was carried out at a fourth level hospital in Colombia during the period 2014-2020.All patients diagnosed with cardiomyopathy of any etiology and AF, who were on an anticoagulation regimen were included.The primary outcome was the incidence of embolic events.A survival analysis was performed using adjusted Cox proportional hazard models.A p-value <0.05 was considered significant.All statistical tests were two-tailed.Results: A total of 149 anticoagulated patients with cardiomyopathy were evaluated (median age: 71 years; women: 30.20%).The cumulative incidence of embolic events was significantly higher in patients with CC (17.50%) compared with those presenting other cardiomyopathies (4.95%), despite that the latter had a significantly higher CHA 2 DS 2 -VASc score (p=0.013).After multivariate analysis, patients with CC had a significantly higher risk of embolic events regardless of the CHA 2 DS 2 -VASc score and the type of anticoagulant prescribed (HR 5.65; p=0.012).Conclusions: Chagasic cardiomyopathy was associated with a significantly higher risk of embolic events, despite anticoagulation therapy in both groups.More research is required to understand the origin of the risk observed in order to translate this knowledge into specific indications for anticoagulation in patients with CC.