TIMI‐AF score and cardiovascular events in vitamin K antagonists‐naïve outpatients with atrial fibrillation

Background The TIMI‐AF score predicts poor outcomes in patients with atrial fibrillation (AF) and guides selection of anticoagulant therapy by identifying clinical benefit of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKA). Hypothesis Our objective was to determine the ability to predict cardiovascular events according to the TIMI‐AF score in a real‐world population. Methods Retrospective observational study of VKA‐naïve patients with AF was seen at a cardiology outpatient clinic in Spain between November 2012 and August 2014. We recorded adverse events (myocardial infarction, systemic embolism or stroke, major bleeding, and death). Results The study population comprised of 426 patients (50.7% men, mean age, 69 ± 14 years). The TIMI‐AF score identified 372 patients (87.3%) with a low risk, 50 patients (11.7%) with an intermediate risk, and 4 patients (0.9%) with a high risk. After a mean follow‐up of 423.4 ± 200.1 days, 37 patients (9%) experienced an adverse event. Patients with a TIMI‐AF score ≥ 7 had a poorer cardiovascular prognosis (HR, 6.1; 95%CI, 3.2‐11.7; P < 0.001). The area under the ROC curve of TIMI‐AF was 0.755 (95%CI, 0.669‐0.840; P < 0.001), which was greater than that of CHA2DS2VASc (0.641; 95%CI, 0.559‐0.724; P = 0.004), HAS‐BLED (0.666; 95%CI, 0.578‐0.755; P < 0.001), and SAMeTT2R2 (0.529; 95%CI, 0.422‐0.636; P = 0.565). Similar results were obtained in relation to the net clinical outcome (life‐threatening bleeding, disabling stroke, or all‐cause mortality). Conclusions The TIMI‐AF risk score can identify patients who are at greater risk of cardiovascular events and a poor net clinical outcome with a better diagnostic yield than CHA2DS2VASc, HAS‐BLED, and SAMeTT2R2.