TY - JOUR
T1 - Should the presence or extent of coronary artery disease be quantified in the CHA2DS2-VASc score in atrial fibrillation?
T2 - A Report from the Western Denmark Heart Registry
AU - Steensig, Kamilla
AU - Olesen, Kevin K W
AU - Thim, Troels
AU - Nielsen, Jens C
AU - Jensen, Svend E
AU - Jensen, Lisette O
AU - Kristensen, Steen D
AU - Bøtker, Hans Erik
AU - Lip, Gregory Y H
AU - Maeng, Michael
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - BACKGROUND: Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included.OBJECTIVES: This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF.MATERIALS AND METHODS: Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants.RESULTS: Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06-1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information.CONCLUSION: Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.
AB - BACKGROUND: Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included.OBJECTIVES: This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF.MATERIALS AND METHODS: Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants.RESULTS: Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06-1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information.CONCLUSION: Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.
KW - coronary angiography
KW - coronary artery disease
KW - prevention
KW - stroke
KW - thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85057733745&partnerID=8YFLogxK
U2 - 10.1055/s-0038-1675401
DO - 10.1055/s-0038-1675401
M3 - Journal article
C2 - 30419601
SN - 0340-6245
VL - 118
SP - 2162
EP - 2170
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 12
ER -