Comparison between CHA 2DS 2-VASc and the new R 2CHADS 2 and ATRIA scores at predicting thromboembolic event in non-anticoagulated and anticoagulated patients with non-valvular atrial fibrillation

BMC Cardiovascular Disorders

Jose Ramón González-Juanatey¹  Carlos Peña-Gil¹  Xesús Alberte Fernandez-López¹  Javier García-Seara¹  Luis Martínez-Sande¹  Moisés Rodríguez-Mañero¹  Sergio Raposeiras-Roubin¹  Andrea López-López¹  Emad Abu-Assi¹  Rami Riziq-Yousef Abumuaileq¹ 

[1] Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain

关键词: Thromboembolism;    Anticoagulant;    Atrial fibrillation;   

Others  :  1234492
DOI  :  10.1186/s12872-015-0149-3

 received in 2015-08-30, accepted in 2015-11-12,  发布年份 2015

【 摘 要 】

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 CHA ₂ DS ₂ -VASc and the recently developed R ₂ CHADS ₂and 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. CHA ₂ DS ₂ -VASc showed significant association with TE occurrence: hazard ratio (HR) = 1.58 (95 % confidence interval [95 % IC] 1.01–2.46), but R ₂ CHADS ₂and 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 CHA ₂ DS ₂ -VASc, R ₂ CHADS ₂and ATRIA, respectively.

In both cohorts, no TE event occurred in patients classified in the low risk category according to CHA ₂ DS ₂ -VASc or R ₂ CHADS ₂ .

Conclusions

In this study of NVAF patients, CHA ₂ DS ₂ -VASc has better association with TE events than the new R ₂ CHADS ₂and ATRIA risk scores in the non-anticoagulated cohort. CHA ₂ DS ₂ -VASc and R ₂ CHADS ₂can identify patients at truly low risk regardless of the anticoagulation status.

【 授权许可】

   
2015 Abumuaileq et al.

【 参考文献 】

• [1]Wolf PA, Abbott RD, Kannel WB: Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991, 22:983-8.
• [2]Hart RG, Benavente O, McBride R, Pearce LA: Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 1999, 131:492-501.
• [3]Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE: Estes NA3rd, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/ American Heart Association task force on practice guidelines. J Am Coll Cardiol 2011, 57:223-42.
• [4]You JJ, Singer DE, Howard PA, Lane DA, Eckman MH, Fang MC, et al.: Antithrombotic therapy for atrial fibrillation: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012, 141:e531S-75.
• [5]Camm AJ, Lip GY, De Caterina R, Atar D, Hohnloser SH, Hindricks G, et al.: 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association. Europace 2012, 14:1385-413.
• [6]Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ: Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation. JAMA 2001, 285:2864-70.
• [7]Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ: Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010, 137:263-72.
• [8]Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY: The value of the CHA 2 DS 2 -VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS 2 score 0–1: a nationwide cohort study. Thromb Haemost 2012, 107:1172-9.
• [9]Coppens M, Eikelboom JW, Hart RG, Yusuf S, Lip GY, Dorian P, et al.: The CHA 2 DS 2 -VASC score identifies those patients with atrial fibrillation and a CHADS 2 of 1 who are unlikely to benefit from oral anticoagulant therapy. Eur Heart J 2013, 34:170-6.
• [10]Van Staa TP, Setakis E, Di Tanna GL, Lane DA, Lip GY: A comparison of risk stratification schemes for stroke in 79,884 atrial fibrillation patients in general practice. J Thromb Haemost 2011, 9:39-48.
• [11]Fang MC, Go AS, Chang Y, Borowsky L, Pomernacki NK, Singer DE, et al.: Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation. J Am Coll Cardiol 2008, 51:810-5.
• [12]Chao TF, Liu CJ, Wang KL, Lin YJ, Chang SL, Lw L, et al.: Using the CHA2DS2-VASc score for refining stroke risk stratification in ‘low-risk’ asian patients with atrial fibrillation. J Am Coll Cardiol 2014, 64:1658-65.
• [13]Piccini JP, Stevens SR, Chang Y, Singer DE, Lokhnygina Y, Go AS, et al.: Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R 2 CHADS 2 index in the ROCKET AF (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study cohorts. Circulation 2013, 127:224-32.
• [14]Singer DE, Chang Y, Borowsky LH, Fang MC, Pomernacki NK, Udaltsova N, et al.: A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc 2013, 2:e000250.
• [15]Dzeshka MS, Lane DA, Lip GY: Stroke and bleeding risk in atrial fibrillation: navigating the alphabet soup of risk-score acronyms (CHADS2, CHA2DS2-VASc, R2CHADS2, HAS-BLED, ATRIA, and More). Clin Cardiol 2014, 37:634-44.
• [16]Abumuaileq RR, Abu-Assi E, Raposeiras-Roubin S, Lopez-Lopez A, Redondo-Dieguez A, Alvarez-Iglesias D, et al.: Evaluation of SAMe-TT2R2 risk score for predicting the quality of anticoagulation control in a real-world cohort of patients with non-valvular atrial fibrillation on vitamin-K antagonists. Europace 2015, 17:711-7.
• [17]Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, et al.: Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007, 53:766-72.
• [18]Baber U, Howard VJ, Halperin JL, Soliman EZ, Zhang X, McClellan W, et al.: Association of chronic kidney disease with atrial fibrillation among adults in the united states. Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Circ Arrhythm Electrophysiol 2011, 4:26-32.
• [19]Rose AJ, Hylek EM, Ozonoff A, Ash AS, Reisman JI, Berlowitz DR: Patient characteristics associated with oral anticoagulation control: results of the Veterans AffaiRs Study to Improve Anticoagulation (VARIA). J Thromb Haemost 2010, 8:2182-91.
• [20]Lip GY, Frison L, Halperin JL, Lane DA: Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 2010, 41:2731-8.
• [21]Hart RG, Pearce LA, Aguilar MI: Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007, 146:857-67.