Key result
Higher CHADS2 and CHA2DS2-VASc scores linked to ~112% greater AMI risk per CHADS2 point in AF.
Why the study?
The predictive value of CHADS2 and CHA2DS2-VASc scores for acute myocardial infarction in patients with atrial fibrillation was unclear.
Do CHADS2 and CHA2DS2-VASc scores predict acute myocardial infarction in patients with nonvalvular atrial fibrillation?
Cohort (n=5,140)
No
Do CHADS2 and CHA2DS2-VASc scores predict acute myocardial infarction in patients with nonvalvular atrial fibrillation?
Odds Ratio: 2.12 (95% CI 1.942–2.315)
p-value: p=<0.001
Both CHADS2 and CHA2DS2-VASc scores have fair, but not significantly different, predictive value for identifying the risk of acute myocardial infarction in patients with nonvalvular atrial fibrillation.
May inform MI risk stratification in AF; hypothesis-generating and requires prospective validation before clinical use.
The presence of acute myocardial infarction (AMI) confers a poor prognosis in atrial fibrillation (AF), associated with increased mortality dramatically. This study aimed to evaluate the predictive value of CHADS2and CHA2DS2-VASc scores for AMI in patients with AF. This retrospective study enrolled 5140 consecutive nonvalvular AF patients, 300 patients with AMI and 4840 patients without AMI. We identified the optimal cut-off values of the CHADS2and CHA2DS2-VASc scores each based on receiver operating characteristic curves to predict the risk of AMI. Both CHADS2score and CHA2DS2-VASc score were associated with an increased odds ratio of the prevalence of AMI in patients with AF, after adjustment for hyperlipidaemia, hyperuricemia, hyperthyroidism, hypothyroidism and obstructive sleep apnea. The present results showed that the area under the curve (AUC) for CHADS2score was 0.787 with a similar accuracy of the CHA2DS2-VASc score (AUC 0.750) in predicting “high-risk” AF patients who developed AMI. However, the predictive accuracy of the two clinical-based risk scores was fair. The CHA2DS2-VASc score has fair predictive value for identifying high-risk patients with AF and is not significantly superior to CHADS2in predicting patients who develop AMI.
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Pang et al. (2017) conducted a cohort in Nonvalvular atrial fibrillation (n=5,140). CHADS2 and CHA2DS2-VASc scores vs. Lower scores was evaluated on Prevalence of acute myocardial infarction (OR 2.120, 95% CI 1.942-2.315, p=<0.001). Higher CHADS2 and CHA2DS2-VASc scores were independently associated with an increased risk of acute myocardial infarction in patients with atrial fibrillation, with CHADS2 yielding an adjusted OR of 2.12 per 1-point increase.
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