The CHA2DS2-VASc score for predicting atrial fibrillation in patients presenting with ST elevation myocardial infarction
prospective observational study
Keywords:
Risk factors, Atrial fibrillation, Myocardial infarctionAbstract
BACKGROUND: Atrial fibrillation (AF) is the most common form of supraventricular arrhythmia following ST-elevation myocardial infarction (STEMI). The CHA2DS2-VASc and CHADS2 scores are used to estimate thromboembolic risk in cases of AF. Their usefulness in predicting the development of AF in patients pre-senting STEMI is unknown. OBJECTIVE: To evaluate the predictive value of the CHADS2 and CHA2DS2-VASc scores in patients with AF following STEMI. DESIGN AND SETTING: This prospective cohort study on 696 patients with STEMI was conducted at a tertiary-level cardiology clinic in a public university hospital. METHODS: Models including clinical and laboratory parameters were constructed to test the predictive value of CHADS2 and CHA2DS2-VASc scores. Patients were divided into two groups: with and without AF. Predictors of AF were determined using multivariate regression analysis. RESULTS: In the patients with AF, CHADS2 and CHA2DS2-VASc scores were significantly higher than in those without AF (for both P < 0.001). Factors associated with AF in multivariate analyses included CHA2DS2-VASc score (odds ratio, OR: 1.48; 95% confidence interval, CI: 1.25-1.75; P < 0.001), peak creatine kinase-myocardial binding (OR: 1.002; 95% CI: 1.00-1.003; P = 0.0024), duration of the coronary intensive care unit stay (OR: 1.69; 95% CI: 1.24-12.30; P = 0.001) and no use of renin-angiotensin system block-ers (OR: 2.16; 95% CI: 1.14-4.10; P = 0.0017). Receiver operating characteristic curve analyses showed that CHA2DS2-VASc scores were significant predictors for new-onset AF (C-statistic: 0.698; 95% CI: 0.631-0.765; P < 0.001). CONCLUSION: CHADS2 and CHA2DS2-VASc scores predicted new AF in patients presenting STEMI.
Downloads
References
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration with EACTS. Rev Esp Cardiol (Engl Ed). 2017;70(1):50. PMID: 28038729; doi: 10.1016/j.rec.2016.11.033.
Uyarel H, Onat A, Yüksel H, et al. Türk halkında kronik atrial fibrilasyon insidansı, prevalansı ve mortalitesine ilişkin tahminler [Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults]. Turk Kardiyoloji Dern Ars. 2008;36(4):214-22. PMID: 18765964.
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962. PMID: 27567408; doi: 10.1093/ eurheartj/ehw210.
Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551-67. PMID: 22922414; doi: 10.1093/eurheartj/ehs184.
The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC) Steg PG, James SK, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569-619. PMID: 22922416; doi: 10.1093/ eurheartj/ehs215.
Folland ED, Parisi AF. Noninvasive evaluation of left ventricular function: the ejection fraction. Compr Ther. 1979;5(7):47-54. PMID: 477284.
Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32e35. PMID: 15405679
Kudaiberdieva G, Gorenek B. Post PCI atrial fibrillation. Acute Card Care. 2007;9(2):69-76. PMID: 17573579; doi: 10.1080/17482940600990285.
Tateyama S, Higuma T, Endo T, et al. Prognostic impact of atrial fibrillation in patients with acute myocardial infarction. Journal of Arrhythmia. 2014;30(6):460-5. doi: 10.1016/j.joa.2013.12.006.
Mehta RH, Dabbous OH, Granger CB, et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. Am J Cardiol. 2003;92(9):1031-6. PMID: 14583352; doi: 10.1016/j.amjcard.2003.06.001.
Al-Khatib SM, Pieper KS, Lee KL, et al. Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: results from the PURSUIT trial. Am J Cardiol. 2001;88(1): A7, 76-9. PMID: 11423065; doi: 10.1016/S0002-9149(01)01593-4.
Jabre P, Jouven X, Adnet F, et al. Atrial fibrillation and death after myocardial infarction: a community study. Circulation. 2011;123(19):2094-100. PMID: 21536994; doi: 10.1161/CIRCULATIONAHA.110.990192.
Ozaydin M, Turker Y, Erdogan D, et al. The association between previous statin use and development of atrial fibrillation in patients presenting with acute coronary syndrome. Int J Cardiol. 2010;141(2):147-50. PMID: 1910600; doi: 10.1016/j.ijcard.2008.11.172.
Yin L, Ling X, Zhang Y, et al. CHADS2 and CHA2DS2-VASc scoring systems for predicting atrial fibrillation following cardiac valve surgery. PloS One. 2015;10(4):e0123858. PMID: 25849563; doi: 10.1371/journal.pone.0123858.
Barkas F, Elisaf M, Korantzopoulos P, Tsiara S, Liberopoulos E. The CHADS2 and CHA2DS2-VASc scores predict atrial fibrillation in dyslipidemic individuals: role of incorporating low high-density lipoprotein cholesterol levels. Int J Cardiol. 2017;241:194-9. PMID: 28442233; doi: 10.1016/j.ijcard.2017.04.062.
Tousoulis D, Antoniades C, Stefanadis C. Assessing inflammatory status in cardiovascular disease. Heart. 2007;93(8):1001-7. PMID: 17639118; doi: 0.1136/hrt.2006.088211.
Ozaydin M. Atrial fibrillation and inflammation. World J Cardiol. 2010;2(8):243-50. PMID: 21160591; doi: 10.4330/wjc.v2.i8.243.
Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J. 2015;79(3):495-502. PMID: 25746525; doi: 10.1253/circj.CJ-15-0138.
Bas HA, Aksoy F, Icli A, et al. The association of plasma oxidative status and inflammation with the development of atrial fibrillation in patients presenting with ST elevation myocardial infarction. Scan J of Clin Lab Invest. 2017;77(2):77-82. PMID: 27905214; doi: 10.1080/00365513.2016.1244857.
Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994;89(2):724-30. PMID: 8313561.
Asanin M, Perunicic J, Mrdovic I, et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. Eur J Heart Fail. 2005;7(4):671-6. PMID: 15921810; doi: 10.1016/j.ejheart.2004.07.018.
Arslan A, Ozaydin M, Aksoy F, et al. Association between the use of renin-angiotensin system blockers and development of in-hospital atrial fibrillation in patients with ST-segment elevation myocardial infarction. Medicina (Kaunas). 2016;52(2):104-9. PMID: 27170483; doi: 10.1016/j.medici.2016.02.006.
Ogunsua AA, Shaikh AY, Ahmed M, McManus DD. Atrial fibrillation and hypertension: mechanistic, epidemiologic, and treatment parallels. Methodist DeBakey Cardiovasc J. 2015;11(4):228. PMID: 27057292; doi: 10.14797/mdcj-11-4-228.
Pizzetti F, Turazza F, Franzosi M, et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart. 2001;86(5):527-32. PMID: 11602545.
Eldar M, Canetti M, Rotstein Z, et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation. 1998;97(10):965-70. PMID: 9529264.
Pedersen OD, Abildstrøm SZ, Ottesen MM, et al. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction. Eur Heart J. 2005;27(3):290-5. PMID: 16267070; doi: 10.1093/eurheartj/ehi629.
