3.3. Risk of SSS
A total of 115 patients with
incident AF developed SSS during the follow-up period of 35,086
person-years, whereas among those without AF, 431 participants developed
SSS. The incidence of SSS was 3.4 and 0.2 per 1000 person-years in the
AF and PS-matched patients without AF, respectively (Table 2). Patients
with AF had a higher cumulative incidence of SSS compared to the overall
(log-rank p<0.001, Figure 3A) and PS-matched patients without
AF (log-rank p<0.001, Figure 3B). After adjustment of clinical
variables and competing risk of mortality, the subjects with incident AF
had an increased risk of SSS with adjusted hazard ratio (HR) of 8.2
(95% CI: 6.5–10.3). After PS matching, incident AF was associated with
significantly increased risk of SSS with adjusted HR of 13.4 (95% CI:
8.4–21.4) (Table 2).
The analysis of censoring for heart failure was performed in patients
without history of heart failure (incident AF, 10,706; no-AF, 265,865).
During the follow-up period, heart failure occurred in 13.2% and 1.4%
patients in the AF and no-AF groups, respectively. After censoring for
heart failure, the incidence of SSS was 2.7 and 0.2 per 1000
person-years in the AF and PS-matched no-AF groups, respectively (Table
2). The incident AF group had a higher cumulative incidence of SSS
compared to the overall (log-rank p<0.001; Figure 3C) and
PS-matched patients without AF (log-rank p<0.001; Figure 3D).
After adjustment for clinical variables and competing risk of mortality,
incident AF was associated with an increased risk of SSS (adjusted HR,
11.4; 95% CI: 8.7–14.9). After
PS matching, compared with PS-matched no-AF group, incident AF was
associated with increased the risk of SSS with adjusted HR of 16.0 (95%
CI: 9.2–28.0) (Table 2).
After censoring for heart failure or acute myocardial infarction,
incident AF had increased risk of SSS compared to the overall (adjusted
HR, 11.6; 95% CI: 8.9–15.2) and PS-matched groups (adjusted HR, 16.9;
95% CI: 9.3–29.7) (Table 2).
In subgroup analysis, incident AF increased the risk of SSS regardless
of sex, age, living in metropolitan cities, economic status, heart
failure, hypertension, diabetes, ischemic stroke/transient ischemic
attack, vascular disease, CHA2DS2-VASc
score, medication for rate control, and antiarrhythmic drugs (Figure 4).