Rami Riziq-Yousef Abumuaileq1, Emad Abu-Assi2, Andrea López-López3, Sergio Raposeiras-Roubin4, Moisés Rodríguez-Mañero5, Luis Martínez-Sande6, Javier García-Seara7, Xesús Alberte Fernandez-López8, Carlos Peña-Gil9, Jose Ramón González-Juanatey10. 1. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. drrami2012@hotmail.com. 2. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. eabuassi@gmail.com. 3. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. andrea.lopez86@hotmail.com. 4. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. raposeiras26@hotmail.com. 5. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. moirmanero@gmail.com. 6. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. luismartinezsande@gmail.com. 7. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. javiergarciaseara@yahoo.es. 8. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. xalberte@yahoo.es. 9. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. carlospenagil@hotmail.com. 10. Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. jose.ramon.gonzalez.juanatey@sergas.es.
Abstract
BACKGROUND: Accurate risk stratification is considered the first and most important step in the management of patients with non-valvular atrial fibrillation (NVAF). We compared the performance of the widely used CHA2DS2-VASc and the recently developed R2CHADS2 and ATRIA scores, for predicting thromboembolic (TE) event in either non-anticoagulated or anticoagulated patients with NVAF. METHODS: The non-anticoagulated cohort was comprised of 154 patients, whereas 911 patients formed the cohort of patients on vitamin-K-antagonist. The scores were computed using the criteria mentioned in their developmental cohorts. Measures of performance for the risk scores were evaluated at predicting TE event. RESULTS: In the non-anticoagulated cohort, 9 TE events occurred during 11 ± 2.7 months. CHA2DS2-VASc showed significant association with TE occurrence: hazard ratio (HR) = 1.58 (95 % confidence interval [95 % IC] 1.01-2.46), but R2CHADS2 and ATRIA did not (HR = 1.23 (95 % CI 0.86-1.77) and 1.20 (95 % CI 0.93-1.56), respectively. In the anticoagulated cohort, after 10 ± 3 months of follow up, 18 TE events were developed. In that cohort, the three scores showed similar association with TE risk: HR = 1.49 (95 % CI 1.13-1.97), 1.41 (95 % CI 1.13-1.77) and 1.37 (95 % CI 1.12-1.66) for CHA2DS2-VASc, R2CHADS2 and ATRIA, respectively. In both cohorts, no TE event occurred in patients classified in the low risk category according to CHA2DS2-VASc or R2CHADS2. CONCLUSIONS: In this study of NVAF patients, CHA2DS2-VASc has better association with TE events than the new R2CHADS2 and ATRIA risk scores in the non-anticoagulated cohort. CHA2DS2-VASc and R2CHADS2 can identify patients at truly low risk regardless of the anticoagulation status.
BACKGROUND: Accurate risk stratification is considered the first and most important step in the management of patients with non-valvular atrial fibrillation (NVAF). We compared the performance of the widely used CHA2DS2-VASc and the recently developed R2CHADS2 and ATRIA scores, for predicting thromboembolic (TE) event in either non-anticoagulated or anticoagulated patients with NVAF. METHODS: The non-anticoagulated cohort was comprised of 154 patients, whereas 911 patients formed the cohort of patients on vitamin-K-antagonist. The scores were computed using the criteria mentioned in their developmental cohorts. Measures of performance for the risk scores were evaluated at predicting TE event. RESULTS: In the non-anticoagulated cohort, 9 TE events occurred during 11 ± 2.7 months. CHA2DS2-VASc showed significant association with TE occurrence: hazard ratio (HR) = 1.58 (95 % confidence interval [95 % IC] 1.01-2.46), but R2CHADS2 and ATRIA did not (HR = 1.23 (95 % CI 0.86-1.77) and 1.20 (95 % CI 0.93-1.56), respectively. In the anticoagulated cohort, after 10 ± 3 months of follow up, 18 TE events were developed. In that cohort, the three scores showed similar association with TE risk: HR = 1.49 (95 % CI 1.13-1.97), 1.41 (95 % CI 1.13-1.77) and 1.37 (95 % CI 1.12-1.66) for CHA2DS2-VASc, R2CHADS2 and ATRIA, respectively. In both cohorts, no TE event occurred in patients classified in the low risk category according to CHA2DS2-VASc or R2CHADS2. CONCLUSIONS: In this study of NVAFpatients, CHA2DS2-VASc has better association with TE events than the new R2CHADS2 and ATRIA risk scores in the non-anticoagulated cohort. CHA2DS2-VASc and R2CHADS2 can identify patients at truly low risk regardless of the anticoagulation status.
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