TY - JOUR

T1 - Predicting stroke in patients without atrial fibrillation

AU - Steensig, Kamilla

AU - Olesen, Kevin K W

AU - Thim, Troels

AU - Nielsen, Jens C

AU - Madsen, Morten

AU - Jensen, Svend E

AU - Jensen, Lisette O

AU - Kristensen, Steen D

AU - Lip, Gregory Y H

AU - Maeng, Michael

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/6

Y1 - 2019/6

N2 - Background: Only few studies in selected cohorts have examined whether the CHA 2DS 2-VASc score can predict the risk of atrial fibrillation and thromboembolic events in patients without atrial fibrillation. Materials and methods: Patients with coronary angiography performed between 2004 and 2012 were grouped according to CHA 2DS 2-VASc score. We excluded patients with atrial fibrillation, anticoagulant therapy and follow-up <30 days. The endpoints were atrial fibrillation and a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. Event rates per 100 person-years were estimated for each CHA 2DS 2-VASc score (0, 1, 2, 3, 4, and >4). Incidence rate ratios were calculated using low-risk patients (CHA 2DS 2-VASc score 0 in males or 1 in females) as reference. Results: In total, 78 233 patients were included with group sizes varying between 8299 (CHA 2DS 2-VASc >4) and 19 882 (CHA 2DS 2-VASc 2). An increasing CHA 2DS 2-VASc score was significantly associated with a future diagnosis of atrial fibrillation (P for trend <0.0001) and an incremental risk of ischaemic stroke, transient ischaemic attack, systemic embolism (P for trend <0.0001) and all-cause death (P for trend <0.0001). Patients with a CHA 2DS 2-VASc score of 3 had a rate of ischaemic stroke/transient ischaemic attack/systemic embolism of 1.30 per 100 person-years. Conclusions: Among patients undergoing coronary angiography, the CHA 2DS 2-VASc score predicted a future diagnosis of atrial fibrillation and the composite risk of ischaemic stroke, transient ischaemic attack or systemic embolism in patients without atrial fibrillation. A CHA 2DS 2-VASc score of 3 was associated with a risk that would justify prophylactic oral anticoagulation treatment in a patient with atrial fibrillation.

AB - Background: Only few studies in selected cohorts have examined whether the CHA 2DS 2-VASc score can predict the risk of atrial fibrillation and thromboembolic events in patients without atrial fibrillation. Materials and methods: Patients with coronary angiography performed between 2004 and 2012 were grouped according to CHA 2DS 2-VASc score. We excluded patients with atrial fibrillation, anticoagulant therapy and follow-up <30 days. The endpoints were atrial fibrillation and a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. Event rates per 100 person-years were estimated for each CHA 2DS 2-VASc score (0, 1, 2, 3, 4, and >4). Incidence rate ratios were calculated using low-risk patients (CHA 2DS 2-VASc score 0 in males or 1 in females) as reference. Results: In total, 78 233 patients were included with group sizes varying between 8299 (CHA 2DS 2-VASc >4) and 19 882 (CHA 2DS 2-VASc 2). An increasing CHA 2DS 2-VASc score was significantly associated with a future diagnosis of atrial fibrillation (P for trend <0.0001) and an incremental risk of ischaemic stroke, transient ischaemic attack, systemic embolism (P for trend <0.0001) and all-cause death (P for trend <0.0001). Patients with a CHA 2DS 2-VASc score of 3 had a rate of ischaemic stroke/transient ischaemic attack/systemic embolism of 1.30 per 100 person-years. Conclusions: Among patients undergoing coronary angiography, the CHA 2DS 2-VASc score predicted a future diagnosis of atrial fibrillation and the composite risk of ischaemic stroke, transient ischaemic attack or systemic embolism in patients without atrial fibrillation. A CHA 2DS 2-VASc score of 3 was associated with a risk that would justify prophylactic oral anticoagulation treatment in a patient with atrial fibrillation.

KW - CHA DS -VASc

KW - coronary angiography

KW - coronary artery disease

KW - prevention

KW - stroke

KW - thromboembolism

KW - ANTICOAGULANTS

KW - RISK STRATIFICATION

KW - GUIDELINES

KW - PREVENTION

KW - CHADS(2)

KW - CHA(2)DS(2)-VASc

KW - HEART

KW - DISEASE

KW - REGISTRY

UR - http://www.scopus.com/inward/record.url?scp=85063797109&partnerID=8YFLogxK

U2 - 10.1111/eci.13103

DO - 10.1111/eci.13103

M3 - Journal article

C2 - 30883728

VL - 49

JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

SN - 0014-2972

IS - 6

M1 - e13103

ER -