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G Renda, F Ricci, G Patti, N Aung, S E Petersen, V Hamrefors, O Melander, G Engstrom, R De Caterina, A Fedorowski, P2885
The CHA2DS2VASc score as a predictor of cardiovascular events in patients without atrial fibrillation, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy565.P2885, https://doi.org/10.1093/eurheartj/ehy565.P2885Close - Share Icon Share
Extract
Background: The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation (AF). However, little is known about its usefulness for prediction of cardiovascular (CV) events and mortality in subjects without AF.
Purpose: We aimed at evaluating and comparing the prognostic significance of the CHA2DS2VASc score for CV morbidity and mortality in populations with and without AF.
Methods: We analysed a population-based prospective cohort of 22,369 middle-aged individuals (mean age 63±7 years; men 39%). We grouped the population into five strata according to the CHA2DS2VASc score (adjusted for sex): CHA2DS2VASc=0, CHA2DS2VASc=1, CHA2DS2VASc=2, CHA2DS2VASc=3 and CHA2DS2VASc≥4, and compared the risk of major adverse cardiac and cerebrovascular events (MACCE) and mortality between subjects without prevalent or incident AF (n=18,637) and patients with history of AF (n=3,542).
Results: Over a median follow-up of 14±4 years, 1572 patients (6.9%) had an ischaemic stroke, 2162 (9.5%) a coronary event, and 5899 (26%) died. Cumulative incidences, absolute and relative risks of MACCE and mortality were greater with increasing sex-adjusted CHA2DS2VASc strata in subjects with and without AF. The cumulative incidence of ischemic stroke in patients without AF according to the CHA2DS2VASc score is shown in the Figure (left panel). The cumulative incidence of ischaemic stroke in CHA2DS2VASc≥4 subjects without AF was similar to that of patients with AF and CHA2DS2VASc=2, particularly during the first 10 years of follow-up (Figure, right panel), with a crude incidence rate of 0.91 (95% CI 0.68–1.19) and 1.12 (95% CI 0.92–1.36) ischaemic strokes per 100 patient-year, respectively. In multivariate Cox regression analysis, a CHA2DS2VASc≥2 was a significant predictor of all-cause death (HR 6.7; 95% CI 5.5–8.1), CV death (HR 10.2; 95% CI 7.0–14.9), ischaemic stroke (HR 7.8; 95% CI 5.8–10.5) and coronary events (HR 6.3; 95% CI 4.9–8.2), regardless of the AF status, age at the event, sex, use of antithrombotic drugs, dyslipidaemia and smoking status.
