Marija Polovina1, Dijana Đikić2, Ana Vlajković3, Matej Vilotijević3, Ivan Milinković2, Milika Ašanin1, Miodrag Ostojić3, Andrew J S Coats4, Petar M Seferović5. 1. Department of Cardiology, Clinical Center of Serbia, 26 Višegradska, 11000 Belgrade, Serbia; School of Medicine, Belgrade University, 8 Doktora Subotića, 11000, Belgrade, Serbia. 2. Department of Cardiology, Clinical Center of Serbia, 26 Višegradska, 11000 Belgrade, Serbia. 3. School of Medicine, Belgrade University, 8 Doktora Subotića, 11000, Belgrade, Serbia. 4. San Raffaele Pisana Scientific Institute, Via della Pisana, 235 00163 Rome, Italy. 5. Department of Cardiology, Clinical Center of Serbia, 26 Višegradska, 11000 Belgrade, Serbia; School of Medicine, Belgrade University, 8 Doktora Subotića, 11000, Belgrade, Serbia. Electronic address: seferovic.petar@gmail.com.
Abstract
BACKGROUND: In addition to thromboembolism, atrial fibrillation (AF) may also predispose to major adverse cardiovascular events (MACE) attributable to coronary artery disease (CAD), including myocardial infarction (MI). The 2MACE score (2 points - Metabolic syndrome and Age≥75years, 1 point - MI/revascularization, Congestive heart failure/ejection-fraction <40%, and thrombo-Embolism) was recently proposed to help identify AF patients at risk of MACE. We assessed the predictive validity of the 2MACE score for MACE occurrence in AF patients free of CAD at baseline. METHODS: Non-valvular AF patients (n=794) without CAD (mean-age, 62.5±12.1years, metabolic syndrome, 34.0%; heart failure/ejection-fraction <40%, 25.7%; thromboembolism, 9.7%) were prospectively followed for 5years, or until MACE (composite of non-fatal/fatal MI, revascularization and cardiovascular death). At inclusion, CAD was excluded by medical history, exercise-stress testing and/or coronary angiography. Also, the 2MACE score was determined. RESULTS: At follow-up, 112 patients experienced MACE (2.8%/year). The 2MACE score demonstrated adequate discrimination (C-statistic, 0.699; 95% confidence interval [CI], 0.648-0.750; P<0.001) and calibration (Hosmer-Lemeshow P=0.79) for MACE. The score was significantly associated with MACE, with the adjusted Hazard Ratio (aHR) of 1.56 (95%CI, 1.35-1.73; P<0.001). As for individual outcomes, the score predicted MI (n=46; aHR, 1.49; 95%CI 1.23-1.80), revascularization (n=32; aHR, 1.41; 95%CI, 1.11-1.80) and cardiovascular death (n=34; aHR, 1.43; 95%CI, 1.14-1.81), all P<0.001. CONCLUSIONS: The 2MACE score successfully predicts future MACE, including incident MI, coronary revascularization and cardiovascular death in AF patients free of CAD at baseline. It may have a role in risk-stratification and primary prevention of MACE in AF patients.
BACKGROUND: In addition to thromboembolism, atrial fibrillation (AF) may also predispose to major adverse cardiovascular events (MACE) attributable to coronary artery disease (CAD), including myocardial infarction (MI). The 2MACE score (2 points - Metabolic syndrome and Age≥75years, 1 point - MI/revascularization, Congestive heart failure/ejection-fraction <40%, and thrombo-Embolism) was recently proposed to help identify AFpatients at risk of MACE. We assessed the predictive validity of the 2MACE score for MACE occurrence in AFpatients free of CAD at baseline. METHODS:Non-valvular AFpatients (n=794) without CAD (mean-age, 62.5±12.1years, metabolic syndrome, 34.0%; heart failure/ejection-fraction <40%, 25.7%; thromboembolism, 9.7%) were prospectively followed for 5years, or until MACE (composite of non-fatal/fatal MI, revascularization and cardiovascular death). At inclusion, CAD was excluded by medical history, exercise-stress testing and/or coronary angiography. Also, the 2MACE score was determined. RESULTS: At follow-up, 112 patients experienced MACE (2.8%/year). The 2MACE score demonstrated adequate discrimination (C-statistic, 0.699; 95% confidence interval [CI], 0.648-0.750; P<0.001) and calibration (Hosmer-Lemeshow P=0.79) for MACE. The score was significantly associated with MACE, with the adjusted Hazard Ratio (aHR) of 1.56 (95%CI, 1.35-1.73; P<0.001). As for individual outcomes, the score predicted MI (n=46; aHR, 1.49; 95%CI 1.23-1.80), revascularization (n=32; aHR, 1.41; 95%CI, 1.11-1.80) and cardiovascular death (n=34; aHR, 1.43; 95%CI, 1.14-1.81), all P<0.001. CONCLUSIONS: The 2MACE score successfully predicts future MACE, including incident MI, coronary revascularization and cardiovascular death in AFpatients free of CAD at baseline. It may have a role in risk-stratification and primary prevention of MACE in AFpatients.
Authors: Marcelo Sanmartín Fernández; Manuel Anguita Sánchez; Fernando Arribas; Gonzalo Barón-Esquivias; Vivencio Barrios; Juan Cosin-Sales; María Asunción Esteve-Pastor; Roman Freixa-Pamias; Iñaki Lekuona; Alejandro I Pérez-Cabeza; Isabel Ureña; José Manuel Vázquez Rodríguez; Carles Rafols Priu; Francisco Marin Journal: Cardiol J Date: 2022-05-27 Impact factor: 3.487
Authors: Ewelina Rogalska; Anna Kurasz; Łukasz Kuźma; Hanna Bachórzewska-Gajewska; Sławomir Dobrzycki; Marek Koziński; Bożena Sobkowicz; Anna Tomaszuk-Kazberuk Journal: Int J Environ Res Public Health Date: 2022-08-21 Impact factor: 4.614