Tze-Fan Chao1, Chia-Jen Liu2, Kang-Ling Wang1, Yenn-Jiang Lin1, Shih-Lin Chang1, Li-Wei Lo1, Yu-Feng Hu1, Ta-Chuan Tuan1, Fa-Po Chung1, Jo-Nan Liao1, Tzeng-Ji Chen3, Gregory Y H Lip4, Shih-Ann Chen5. 1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. 2. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan. 3. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 4. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. 5. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: epsachen@ms41.hinet.net.
Abstract
BACKGROUND: Renal dysfunction is a significant risk factor for ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence among AF patients with end-stage renal disease (ESRD) are unclear. OBJECTIVE: The purpose of this study was to compare the CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in AF patients with ESRD. METHODS: A total of 10,999 AF patients with ESRD undergoing renal replacement therapy who were not receiving oral anticoagulants or antiplatelet agents were identified from Taiwan's National Health Insurance Research Database. The study end-point was occurrence of ischemic stroke. RESULTS: The median (interquartile) CHADS2 and CHA2DS2-VASc scores for the study cohort were 3 (2-5) and 5 (4-7), respectively. During follow-up, 1217 patients (11.7%) experienced ischemic stroke, with an incidence rate of 6.9 per 100 person-years. In Cox regression models, the CHADS2 and CHA2DS2-VASc scores both were significant predictors of ischemic stroke. C-indexes for CHADS2 and CHA2DS2-VASc were 0.608 and 0.682, respectively (P < .001). CHA2DS2-VASc improved the net reclassification index by 4.8% compared with CHADS2 (P < .0001). Among 1409 patients with a CHADS2 score of 0 or 1, the CHA2DS2-VASc score ranged from 1 to 4, with event rates ranging from 2.1 to 4.7 per 100 person-years. CONCLUSION: The CHA2DS2-VASc score was useful in predicting ischemic stroke in AF patients with ESRD undergoing dialysis and was superior to the CHADS2 score. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high-risk patients remains to be defined.
BACKGROUND:Renal dysfunction is a significant risk factor for ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence among AFpatients with end-stage renal disease (ESRD) are unclear. OBJECTIVE: The purpose of this study was to compare the CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in AFpatients with ESRD. METHODS: A total of 10,999 AFpatients with ESRD undergoing renal replacement therapy who were not receiving oral anticoagulants or antiplatelet agents were identified from Taiwan's National Health Insurance Research Database. The study end-point was occurrence of ischemic stroke. RESULTS: The median (interquartile) CHADS2 and CHA2DS2-VASc scores for the study cohort were 3 (2-5) and 5 (4-7), respectively. During follow-up, 1217 patients (11.7%) experienced ischemic stroke, with an incidence rate of 6.9 per 100 person-years. In Cox regression models, the CHADS2 and CHA2DS2-VASc scores both were significant predictors of ischemic stroke. C-indexes for CHADS2 and CHA2DS2-VASc were 0.608 and 0.682, respectively (P < .001). CHA2DS2-VASc improved the net reclassification index by 4.8% compared with CHADS2 (P < .0001). Among 1409 patients with a CHADS2 score of 0 or 1, the CHA2DS2-VASc score ranged from 1 to 4, with event rates ranging from 2.1 to 4.7 per 100 person-years. CONCLUSION: The CHA2DS2-VASc score was useful in predicting ischemic stroke in AFpatients with ESRD undergoing dialysis and was superior to the CHADS2 score. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high-risk patients remains to be defined.
Authors: Salina P Waddy; Allen J Solomon; Adan Z Becerra; Julia B Ward; Kevin E Chan; Chyng-Wen Fwu; Jenna M Norton; Paul W Eggers; Kevin C Abbott; Paul L Kimmel Journal: J Am Soc Nephrol Date: 2020-02-20 Impact factor: 10.121
Authors: An S De Vriese; Rogier Caluwé; Lotte Pyfferoen; Dirk De Bacquer; Koen De Boeck; Joost Delanote; Didier De Surgeloose; Piet Van Hoenacker; Bruno Van Vlem; Francis Verbeke Journal: J Am Soc Nephrol Date: 2019-11-08 Impact factor: 10.121