Wobo Bekwelem1, Paul N Jensen2, Faye L Norby2, Elsayed Z Soliman2, Sunil K Agarwal2, Gregory Y H Lip2, Wei Pan2, Aaron R Folsom2, W T Longstreth2, Alvaro Alonso2, Susan R Heckbert2, Lin Y Chen2. 1. From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.). bekwe001@umn.edu. 2. From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
Abstract
BACKGROUND AND PURPOSE: Whether consideration of carotid intima-media thickness (cIMT) and carotid plaque would improve risk prediction of ischemic stroke in persons with atrial fibrillation (AF) is unknown. The purpose of this study was to assess the improvement in risk prediction of stroke by adding cIMT and carotid plaque to the CHA2DS2-VASc (variables age, heart failure, hypertension, diabetes mellitus, myocardial infarction, and peripheral arterial disease) score. METHODS: We included participants from the Atherosclerosis Risk in Communities (ARIC) study (mean age, 63 years) who developed AF within 5 years after carotid measurement, were not on warfarin, and had no prior stroke at AF diagnosis. AF was ascertained from study ECGs and diagnosis codes, and stroke was physician adjudicated. Multivariable Cox models were used to assess association between carotid indices and ischemic stroke. Improvement in 10-year risk prediction of stroke was assessed by the C-statistic, net reclassification improvement, and relative integrated discrimination improvement. RESULTS: There were 81 (11.2%) stroke events that occurred among 724 participants with AF during a mean follow-up of 8.5 years. Increased cIMT and presence of carotid plaque were significantly associated with increased stroke risk. The addition of cIMT+plaque to the CHA2DS2-VASc score marginally increased the C-statistic (95% confidence interval) from 0.685 (0.623-0.747) to 0.698 (0.638-0.759). The net reclassification improvement and integrated discrimination improvement for cIMT+plaque were 0.091 (95% confidence interval, 0.012-0.170) and 0.101 (95% confidence interval, 0.002-0.226), respectively. CONCLUSIONS: Increased cIMT and presence of carotid plaque are associated with increased risk of ischemic stroke in individuals with AF. Furthermore, they may improve risk prediction of stroke, over and above the CHA2DS2-VASc score.
BACKGROUND AND PURPOSE: Whether consideration of carotid intima-media thickness (cIMT) and carotid plaque would improve risk prediction of ischemic stroke in persons with atrial fibrillation (AF) is unknown. The purpose of this study was to assess the improvement in risk prediction of stroke by adding cIMT and carotid plaque to the CHA2DS2-VASc (variables age, heart failure, hypertension, diabetes mellitus, myocardial infarction, and peripheral arterial disease) score. METHODS: We included participants from the Atherosclerosis Risk in Communities (ARIC) study (mean age, 63 years) who developed AF within 5 years after carotid measurement, were not on warfarin, and had no prior stroke at AF diagnosis. AF was ascertained from study ECGs and diagnosis codes, and stroke was physician adjudicated. Multivariable Cox models were used to assess association between carotid indices and ischemic stroke. Improvement in 10-year risk prediction of stroke was assessed by the C-statistic, net reclassification improvement, and relative integrated discrimination improvement. RESULTS: There were 81 (11.2%) stroke events that occurred among 724 participants with AF during a mean follow-up of 8.5 years. Increased cIMT and presence of carotid plaque were significantly associated with increased stroke risk. The addition of cIMT+plaque to the CHA2DS2-VASc score marginally increased the C-statistic (95% confidence interval) from 0.685 (0.623-0.747) to 0.698 (0.638-0.759). The net reclassification improvement and integrated discrimination improvement for cIMT+plaque were 0.091 (95% confidence interval, 0.012-0.170) and 0.101 (95% confidence interval, 0.002-0.226), respectively. CONCLUSIONS: Increased cIMT and presence of carotid plaque are associated with increased risk of ischemic stroke in individuals with AF. Furthermore, they may improve risk prediction of stroke, over and above the CHA2DS2-VASc score.
Authors: A John Camm; Gregory Y H Lip; Raffaele De Caterina; Irene Savelieva; Dan Atar; Stefan H Hohnloser; Gerhard Hindricks; Paulus Kirchhof Journal: Eur Heart J Date: 2012-08-24 Impact factor: 29.983
Authors: Craig T January; L Samuel Wann; Joseph S Alpert; Hugh Calkins; Joaquin E Cigarroa; Joseph C Cleveland; Jamie B Conti; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Katherine T Murray; Ralph L Sacco; William G Stevenson; Patrick J Tchou; Cynthia M Tracy; Clyde W Yancy Journal: Circulation Date: 2014-03-28 Impact factor: 29.690
Authors: R L Sacco; B Boden-Albala; R Gan; X Chen; D E Kargman; S Shea; M C Paik; W A Hauser Journal: Am J Epidemiol Date: 1998-02-01 Impact factor: 4.897
Authors: Wobo Bekwelem; Jeffrey R Misialek; Suma Konety; Scott D Solomon; Elsayed Z Soliman; Laura R Loehr; Faye L Lopez; Ervin R Fox; Thomas H Mosley; Alvaro Alonso Journal: PLoS One Date: 2014-10-16 Impact factor: 3.240