Comparison of the 2MACE and TIMI-AF Scores for Composite Clinical Outcomes in Anticoagulated Atrial Fibrillation Patients

Background: Two risk scores have been developed to predict composite outcomes in atrial fibrillation (AF): the 2MACE and TIMI-AF scores. The aim of this study was to compare the predictive ability of these scores in 2 separate warfarin-treated cohorts (one ‘real world’, one clinical trial) of AF patients. Methods and Results: The 2MACE and TIMI-AF scores were calculated in the ‘real-world’ ATHERO-AF cohort (n=907), and in the randomized controlled AMADEUS trial (n=2,265). Endpoints were major adverse cardiovascular events (MACEs), net clinical outcomes (NCO) and a combination of them, namely “clinically relevant events” (CREs). ROC curves showed similar predictive ability for MACE for 2MACE and TIMI-AF, in both the ATHERO-AF (0.698 vs. 0.688, respectively P=0.783) and AMADEUS (0.657 vs. 0.569, respectively P=0.057) cohorts. Similarly, the TIMI-AF showed a comparable c-index with 2MACE for NCOs in the ATHERO-AF (0.676 vs. 0.667, P=0.737), and AMADEUS (0.666 vs. 0.663, P=0.859) cohorts. No differences were found between the 2 scores for the prediction of CREs (0.675 vs. 0.684, P=0.740 in ATHERO-AF and 0.669 vs. 0.667, P=0.889 in AMADEUS for 2MACE and TIMI-AF, respectively). Conclusions: This study showed that the 2MACE and TIMI-AF scores had modest but significant predictive ability for composite outcomes in AF. The clinical usefulness of both scores was similar, but the 2MACE score may be simpler and easy to use.