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Coronary artery disease (CAD) and Atrial fibrillation (AF) have close relationship and interact with each other. The coexistence of the two diseases increases the risk of future cardiovascular events and stroke dramatically. The CHADS2 and CHA2DS2-VASc scoring systems have been proved efficacy to stratify stroke and thromboembolism risk in patients with non-valvular AF (NVAF). The objective of our study was to investigate the predictive value of CHADS2 and CHA2DS2-VASc scores for acute myocardial infarction (AMI) risk in AF, and subsequently compare the accuracy of the CHADS2 score with CHA2DS2-VASc score in predicting the AMI incidence.
This study enrolled 5140 consecutive patients with NVAF who presented to our department of cardiology from November 2013 to October 2016. The following information was collected from the database: age, gender, history of CAD, congestive heart failure (HF), hypertension, diabetes mellitus (DM), stroke or transient ischemic attack (TIA), thromboembolism, vascular disease, hyperlipidaemia, hyperuricemia, hyperthyroidism, hypothyroidism and obstructive sleep apnea (OSA). We identified the optimal cut-off values of the CHADS2 and CHA2DS2-VASc scores each based on receiver operating characteristic (ROC) curves to predict the risk of AMI. The differences between the areas under the two ROC curves were assessed by a univariate z-score test.
Both CHADS2 score 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 CHADS2 score 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 CHADS2 in predicting patients who develop AMI.
Focusing specifically on risk stratification of AMI by the CHADS2 and CHA2DS2-VASc scores as well as means for optimizing outcomes in the treatment of AF is the significance of our study. Even if the accumulated evidence has shown that CHA2DS2-VASc is better at identifying ‘truly low-risk’ patients with AF who develop stroke and thromboembolism, our data demonstrate that CHA2DS2-VASc is not significantly superior to CHADS2 for predicting AMI in AF patients.