CHA2 DS2 -VASc impact on risk following percutaneous coronary intervention in atrial fibrillation

Thomas Jensen; Pernille Gro Thrane; Kevin Kris Warnakula Olesen; Morten Würtz; Jens Cosedis Nielsen; Lisette Okkels Jensen; Morten Madsen; Troels Thim; Steen Dalby Kristensen; Gregory Y H Lip; Michael Maeng

doi:10.1111/eci.13717

CHA2 DS2 -VASc impact on risk following percutaneous coronary intervention in atrial fibrillation

Thomas Jensen, Pernille Gro Thrane, Kevin Kris Warnakula Olesen, Morten Würtz, Jens Cosedis Nielsen, Lisette Okkels Jensen, Morten Madsen, Troels Thim, Steen Dalby Kristensen, Gregory Y H Lip, Michael Maeng

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

AIMS: In 2010, the European Society of Cardiology Guidelines on atrial fibrillation (AF) introduced the CHA2 DS2 -VASc score to guide initiation of oral anticoagulation. In patients with AF undergoing percutaneous coronary intervention (PCI), triple therapy with oral anticoagulation and dual antiplatelet therapy was recommended to reduce ischemic risk. We examined how the CHA2 DS2 -VASc score impacted oral anticoagulation use and risks of ischemic and hospitalized bleeding events in patients with AF undergoing PCI.

METHODS: We included 6014 patients with AF undergoing first-time PCI in Western Denmark between 2003 and 2017. We divided patients into four groups based on year of PCI and estimated one-year risks of major adverse cardiac events (MACE) and hospitalization for bleeding.

RESULTS: The proportion of oral anticoagulation users was 48% in 2003-2006 and 49% in 2006-2010. Following the CHA2 DS2 -VASc score implementation, the proportion increased to 59% in 2011-2014, and 77% in 2015-2017. Using 2003-2006 as reference, risks of MACE were similar in 2007-2010 (adjusted relative risk [RRadj ] 0.99, 95% confidence interval [CI] 0.83-1.18) and 2011-2014 (RRadj 0.92, 95% CI 0.78-1.09), but declined by 23% in 2015-2017 (RRadj 0.77, 95% CI 0.65-0.92). Hospitalizations for bleeding did not increase despite wider use of triple therapy.

CONCLUSION: Implementation of the CHA2 DS2 -VASc score in the 2010 European guidelines on AF was associated with an increased utilization of oral anticoagulation and triple therapy among AF patients undergoing PCI. These changes were associated with a gradual decline in the risk of MACE, while the risk of hospitalized bleeding remained unchanged.

Original language	English
Article number	e13717
Journal	European Journal of Clinical Investigation
Volume	52
Issue	4
Pages (from-to)	e13717
Number of pages	10
ISSN	0960-135X
DOIs	https://doi.org/10.1111/eci.13717
Publication status	Published - Apr 2022

Keywords

CHA DS -VASc
atrial fibrillation
bleeding
percutaneous coronary intervention
thromboembolism
Risk Assessment
Administration, Oral
Humans
Male
Stroke/etiology
Anticoagulants/administration & dosage
Aged, 80 and over
Female
Aged
Atrial Fibrillation/complications
Percutaneous Coronary Intervention
Practice Guidelines as Topic

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10.1111/eci.13717

Cite this

Jensen, T., Thrane, P. G., Olesen, K. K. W., Würtz, M., Nielsen, J. C., Jensen, L. O., Madsen, M., Thim, T., Dalby Kristensen, S., Lip, G. Y. H., & Maeng, M. (2022). CHA2 DS2 -VASc impact on risk following percutaneous coronary intervention in atrial fibrillation. European Journal of Clinical Investigation, 52(4), e13717. Article e13717. https://doi.org/10.1111/eci.13717

@article{311749cb0d2a49fea1b01d8a5f83cf4a,

title = "CHA2 DS2 -VASc impact on risk following percutaneous coronary intervention in atrial fibrillation",

abstract = "AIMS: In 2010, the European Society of Cardiology Guidelines on atrial fibrillation (AF) introduced the CHA2 DS2 -VASc score to guide initiation of oral anticoagulation. In patients with AF undergoing percutaneous coronary intervention (PCI), triple therapy with oral anticoagulation and dual antiplatelet therapy was recommended to reduce ischemic risk. We examined how the CHA2 DS2 -VASc score impacted oral anticoagulation use and risks of ischemic and hospitalized bleeding events in patients with AF undergoing PCI.METHODS: We included 6014 patients with AF undergoing first-time PCI in Western Denmark between 2003 and 2017. We divided patients into four groups based on year of PCI and estimated one-year risks of major adverse cardiac events (MACE) and hospitalization for bleeding.RESULTS: The proportion of oral anticoagulation users was 48% in 2003-2006 and 49% in 2006-2010. Following the CHA2 DS2 -VASc score implementation, the proportion increased to 59% in 2011-2014, and 77% in 2015-2017. Using 2003-2006 as reference, risks of MACE were similar in 2007-2010 (adjusted relative risk [RRadj ] 0.99, 95% confidence interval [CI] 0.83-1.18) and 2011-2014 (RRadj 0.92, 95% CI 0.78-1.09), but declined by 23% in 2015-2017 (RRadj 0.77, 95% CI 0.65-0.92). Hospitalizations for bleeding did not increase despite wider use of triple therapy.CONCLUSION: Implementation of the CHA2 DS2 -VASc score in the 2010 European guidelines on AF was associated with an increased utilization of oral anticoagulation and triple therapy among AF patients undergoing PCI. These changes were associated with a gradual decline in the risk of MACE, while the risk of hospitalized bleeding remained unchanged.",

keywords = "CHA DS -VASc, atrial fibrillation, bleeding, percutaneous coronary intervention, thromboembolism, Risk Assessment, Administration, Oral, Humans, Male, Stroke/etiology, Anticoagulants/administration & dosage, Aged, 80 and over, Female, Aged, Atrial Fibrillation/complications, Percutaneous Coronary Intervention, Practice Guidelines as Topic",

author = "Thomas Jensen and Thrane, {Pernille Gro} and Olesen, {Kevin Kris Warnakula} and Morten W{\"u}rtz and Nielsen, {Jens Cosedis} and Jensen, {Lisette Okkels} and Morten Madsen and Troels Thim and {Dalby Kristensen}, Steen and Lip, {Gregory Y H} and Michael Maeng",

year = "2022",

month = apr,

doi = "10.1111/eci.13717",

language = "English",

volume = "52",

pages = "e13717",

journal = "European Journal of Clinical Investigation",

issn = "0960-135X",

publisher = "Wiley-Blackwell Publishing Ltd.",

number = "4",

}

CHA2 DS2 -VASc impact on risk following percutaneous coronary intervention in atrial fibrillation. / Jensen, Thomas ; Thrane, Pernille Gro ; Olesen, Kevin Kris Warnakula et al.
In: European Journal of Clinical Investigation, Vol. 52, No. 4, e13717, 04.2022, p. e13717.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - CHA2 DS2 -VASc impact on risk following percutaneous coronary intervention in atrial fibrillation

AU - Jensen, Thomas

AU - Thrane, Pernille Gro

AU - Olesen, Kevin Kris Warnakula

AU - Würtz, Morten

AU - Nielsen, Jens Cosedis

AU - Jensen, Lisette Okkels

AU - Madsen, Morten

AU - Thim, Troels

AU - Dalby Kristensen, Steen

AU - Lip, Gregory Y H

AU - Maeng, Michael

PY - 2022/4

Y1 - 2022/4

N2 - AIMS: In 2010, the European Society of Cardiology Guidelines on atrial fibrillation (AF) introduced the CHA2 DS2 -VASc score to guide initiation of oral anticoagulation. In patients with AF undergoing percutaneous coronary intervention (PCI), triple therapy with oral anticoagulation and dual antiplatelet therapy was recommended to reduce ischemic risk. We examined how the CHA2 DS2 -VASc score impacted oral anticoagulation use and risks of ischemic and hospitalized bleeding events in patients with AF undergoing PCI.METHODS: We included 6014 patients with AF undergoing first-time PCI in Western Denmark between 2003 and 2017. We divided patients into four groups based on year of PCI and estimated one-year risks of major adverse cardiac events (MACE) and hospitalization for bleeding.RESULTS: The proportion of oral anticoagulation users was 48% in 2003-2006 and 49% in 2006-2010. Following the CHA2 DS2 -VASc score implementation, the proportion increased to 59% in 2011-2014, and 77% in 2015-2017. Using 2003-2006 as reference, risks of MACE were similar in 2007-2010 (adjusted relative risk [RRadj ] 0.99, 95% confidence interval [CI] 0.83-1.18) and 2011-2014 (RRadj 0.92, 95% CI 0.78-1.09), but declined by 23% in 2015-2017 (RRadj 0.77, 95% CI 0.65-0.92). Hospitalizations for bleeding did not increase despite wider use of triple therapy.CONCLUSION: Implementation of the CHA2 DS2 -VASc score in the 2010 European guidelines on AF was associated with an increased utilization of oral anticoagulation and triple therapy among AF patients undergoing PCI. These changes were associated with a gradual decline in the risk of MACE, while the risk of hospitalized bleeding remained unchanged.

AB - AIMS: In 2010, the European Society of Cardiology Guidelines on atrial fibrillation (AF) introduced the CHA2 DS2 -VASc score to guide initiation of oral anticoagulation. In patients with AF undergoing percutaneous coronary intervention (PCI), triple therapy with oral anticoagulation and dual antiplatelet therapy was recommended to reduce ischemic risk. We examined how the CHA2 DS2 -VASc score impacted oral anticoagulation use and risks of ischemic and hospitalized bleeding events in patients with AF undergoing PCI.METHODS: We included 6014 patients with AF undergoing first-time PCI in Western Denmark between 2003 and 2017. We divided patients into four groups based on year of PCI and estimated one-year risks of major adverse cardiac events (MACE) and hospitalization for bleeding.RESULTS: The proportion of oral anticoagulation users was 48% in 2003-2006 and 49% in 2006-2010. Following the CHA2 DS2 -VASc score implementation, the proportion increased to 59% in 2011-2014, and 77% in 2015-2017. Using 2003-2006 as reference, risks of MACE were similar in 2007-2010 (adjusted relative risk [RRadj ] 0.99, 95% confidence interval [CI] 0.83-1.18) and 2011-2014 (RRadj 0.92, 95% CI 0.78-1.09), but declined by 23% in 2015-2017 (RRadj 0.77, 95% CI 0.65-0.92). Hospitalizations for bleeding did not increase despite wider use of triple therapy.CONCLUSION: Implementation of the CHA2 DS2 -VASc score in the 2010 European guidelines on AF was associated with an increased utilization of oral anticoagulation and triple therapy among AF patients undergoing PCI. These changes were associated with a gradual decline in the risk of MACE, while the risk of hospitalized bleeding remained unchanged.

KW - CHA DS -VASc

KW - atrial fibrillation

KW - bleeding

KW - percutaneous coronary intervention

KW - thromboembolism

KW - Risk Assessment

KW - Administration, Oral

KW - Humans

KW - Male

KW - Stroke/etiology

KW - Anticoagulants/administration & dosage

KW - Aged, 80 and over

KW - Female

KW - Aged

KW - Atrial Fibrillation/complications

KW - Percutaneous Coronary Intervention

KW - Practice Guidelines as Topic

U2 - 10.1111/eci.13717

DO - 10.1111/eci.13717

M3 - Journal article

C2 - 34792181

SN - 0960-135X

VL - 52

SP - e13717

JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

IS - 4

M1 - e13717

ER -

CHA2 DS2 -VASc impact on risk following percutaneous coronary intervention in atrial fibrillation

Abstract

Keywords

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