Author + information
- Benjamin Davies Hornea,b,
- T. Jared Buncha,b,
- Heidi Maya,b,
- Kirk Knowltona,b,
- Joseph B. Muhlesteina,b,
- Kevin G. Gravesa,b,
- Victoria Jacobsa,b and
- Donald Lappea,b
Background: Oral anticoagulation therapy (OAC) guidelines recommend using CHA2DS2-VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2DS2-VASc is challenged by its predictive ability. Based on complete blood count and basic metabolic profile, the Intermountain Mortality Risk Score (IMRS) is extensively validated. This study evaluated whether use of IMRS with CHA2DS2-VASc in AF patients improves prediction.
Methods: AF patients undergoing cardiac catheterization (N=10,073) were followed for stroke and mortality (mean 5.8±4.1 years, max: 19 years). CHA2DS2-VASc and IMRS were calculated at baseline. IMRS categories were previously defined. Cox regression adjusted for 20 demographic, clinical, and treatment variables.
Results: In females (n=4,121, mean age 71±12 years) the composite of stroke/mortality was stratified (all p-trend< 0.001) by CHA2DS2-VASc (1, 2, ≥3: 14%, 25%, 49%) and IMRS (low, moderate, high-risk: 18%, 41%, 64%), as it was for males (n=5,952, mean age 68±12 years) by CHA2DS2-VASc (0, 1, 2, ≥3: 8%, 22%, 33%, 54%) and IMRS (low, moderate, high-risk: 19%, 42%, 66%). IMRS stratified stroke/mortality (all p-trend<0.001) in each CHA2DS2-VASc category (females: 1, 2, ≥3; males: 0, 1, 2, ≥3). See Figure for CHA2DS2-VASc = 2 example.
Conclusions: Using IMRS with CHA2DS2-VASc in AF patients improved stroke/mortality prediction. For example, in patients at the OAC treatment threshold (CHA2DS2-VASc=2), IMRS provided ≈4-fold separation between low and high risk.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Miscellaneous and Surgical Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1236-076
- 2017 American College of Cardiology Foundation