Evidence map›Paper›PMID 40294164›Full record

Trial reportJournal of cardiovascular electrophysiology2025

Premature Atrial Contractions as a Marker of Atrial Cardiopathy: A Revised Analysis of the ARCADIA Randomized Trial.

Adi Elias, Justin T Teraoka, Elsayed Z Soliman, Mitchell S V Elkind, Hooman Kamel, Richard A Kronmal, W T Longstreth, David L Tirschwell, Marco R Di Tullio, Gregory M Marcus

Registry-linked trialAbstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of cardiovascular electrophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03192215 (AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03192215 phase3terminatednot on this map

AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke

TypeinterventionalSponsorColumbia UniversityRan2018 to 2023Enrolled1,015ConditionsStrokeArmsApixaban, Aspirin
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Adi EliasDivision of Cardiology, University of California San Francisco, San Francisco, California, USA.
Justin T TeraokaDivision of Cardiology, University of California San Francisco, San Francisco, California, USA.ORCID 0000-0002-6070-2106
Elsayed Z SolimanDepartment of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Mitchell S V ElkindDepartment of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Hooman KamelDepartment of Neurology, Weill Cornell Medicine, New York, New York, USA.
Richard A KronmalDepartment of Biostatistics, University of Washington Seattle, Seattle, Washington, USA.
W T LongstrethDepartment of Neurology, University of Washington, Seattle, Wishington, USA.
David L TirschwellDepartment of Neurology, University of Washington, Seattle, Wishington, USA.
Marco R Di TullioDepartment of Medicine, Columbia University, New York, New York, USA.
Gregory M MarcusDivision of Cardiology, University of California San Francisco, San Francisco, California, USA.

Funding

AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenicstroke (ARCADIA)U01NS095869 · NINDS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI BRODERICK, JOSEPH PAUL, KAMEL, HOOMAN · 2017 to 2022
$22.0M
NINDS NIH HHS U01 NS095869This study was supported by National Institutes of Health (Grant Number 1U01NS095869), BMS-Pfizer Alliance, and Roche Diagnostics.
6 · The paper itself

Abstract

introductionAtrial cardiopathy may be associated with an increased risk of stroke independent of atrial fibrillation (AF). In the ARCADIA trial, apixaban was not superior to aspirin in preventing recurrent stroke among patients with a cryptogenic stroke and atrial cardiopathy. We aimed to determine whether the presence of at least one premature atrial complex (PAC), a known harbinger of AF and stroke, would enhance the ability to identify individuals most likely to benefit from apixaban.

methodsIn ARCADIA, atrial cardiopathy was defined by NT-proBNP > 250 pg/mL, a P-wave terminal force greater than 5000 μV × ms in lead V1, or a left atrial diameter index ≥ 3 cm/m² on echocardiogram. For the current analysis, the presence of any PAC on the baseline 12-lead ECG was substituted for the less atrial-specific NT-proBNP criterion. The presence of any PAC was also assessed as a sole atrial cardiopathy criterion.

resultsOf the 1015 patients randomized in ARCADIA, 85 had at least one PAC. The revised atrial cardiopathy criteria were met by 593 patients; 301 were randomized to apixaban and 292 to aspirin. The annualized recurrent stroke rates were 3.1% for apixaban versus 4.4% for aspirin (HR 0.71, 95% CI: 0.38-1.34, p = 0.29). No differences in risk of recurrent stroke among participants with PACs, compared to those without PACs, were observed.

conclusionIn patients enrolled in the ARCARDIA trial, utilizing the presence of PACs as a potential marker of atrial cardiopathy did not reveal definitive evidence of benefit of apixaban compared to aspirin.

trial registrationClinicalTrials.gov identifier: NCT03192215.

Indexed as

Atrial FibrillationAtrial Premature ComplexesPyrazolesStrokeAgedAspirinBiomarkersElectrocardiographyFactor Xa InhibitorsFemaleHumansMaleMiddle AgedNatriuretic Peptide, BrainPeptide FragmentsPredictive Value of TestsapixabanAspirinBiomarkersFactor Xa InhibitorsNatriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)PyrazolesPyridonesapixabanatrial cardiopathycryptogenic strokepremature atrial complexes

Identifiers

PMID40294164
PMCPMC13120839

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.