Cancer diagnosis significantly increased the incidence of ischemic stroke in patients with atrial fibrillation by 25% (IRR 1.25) compared to patients without cancer.
Cohort (n=101,185)
Sí
Does the incorporation of cancer into the CHA2DS2-VASc score improve the prediction of stroke in patients with atrial fibrillation?
Incorporating cancer diagnosis into the CHA2DS2-VASc score improves stroke risk prediction in patients with atrial fibrillation.
Estimación del efecto: IRR 1.25 (95% CI 1.18-1.31)
Tasa de eventos absoluta: 2.962% vs 2.377%
valor p: p=<0.01
Atrial fibrillation (AF) is associated with an increased risk of stroke. Despite evidence linking cancer and thrombosis, cancer is not part of the CHA2DS2VASc score. Cancer is an independent risk factor for thromboembolic stroke in patients with AF. The SEER database was utilized to identify patients with lung, colon, breast, and prostate cancers with AF and no prior diagnosis of stroke and. compared to controls within the dataset. The primary endpoint was rates of stroke per 100 person-years. Cox regression modeling and a nested model comparing CHA2DS2VASc score (Model 1) with a complete model including cancer diagnosis (Model 2) were performed. Models were compared using Akaike Information Criterion (AIC) and Net Reclassification Index (NRI). A propensity-matched cohort with equivalent CHA2DS2VASc scores determining stroke-free survival was also performed. A total of 101,185 patients were included in the analysis, with 48,242 in the Cancer and 52,943 in the Non-cancer Group. Stroke rate per 100 person-years was significantly higher in the Cancer Group. The CHA2DS2VASc model (Model 1) was compared against a model including cancer (Model 2) showing improved predictability as assessed by both NRI and AIC. Cox regression analysis calculated a hazard ratio of 1.085 for Cancer, which was comparable to age >75, female sex, and diabetes. Propensity matched Kaplan-Meier curve demonstrated a decreased probability of stroke-free survival in the Cancer Group. Cancers increase the risk of stroke in patients with AF. Consideration should be given to the addition of cancer to the clinical scoring system.
Bungo et al. (Mon,) conducted a cohort in Atrial fibrillation (n=101,185). Cancer diagnosis (lung, colon, breast, prostate) vs. No cancer diagnosis was evaluated on Ischemic stroke rate per 100 person-years (IRR 1.25, 95% CI 1.18-1.31, p=<0.01). Cancer diagnosis significantly increased the incidence of ischemic stroke in patients with atrial fibrillation by 25% (IRR 1.25) compared to patients without cancer.