Comparison of the reliability and validity of four contemporary risk stratification schemes to predict thromboembolism in non-anticoagulated patients with atrial fibrillation

• Published in: International journal of cardiology Vol. 166; no. 1; pp. 205 - 209
• Main Authors: Abu-Assi, E, Otero-Raviña, F, Allut Vidal, G, Coutado Méndez, A, Vaamonde Mosquera, L, Sánchez Loureiro, M, Caneda Villar, M.C, Fernández Villaverde, J.M, Maestro Saavedra, F.J, González-Juanatey, J.R
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 05.06.2013; Elsevier
• Subjects: Aged; Aged, 80 and over; Anticoagulants; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Biological and medical sciences; Blood and lymphatic vessels; Blood Coagulation - physiology; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular; Cohort Studies; Contraindications; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Neurology; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Risk Assessment - methods; Risk Assessment - standards; Risk Factors; Risk stratification; Stroke; Thromboembolism; Thromboembolism - diagnosis; Thromboembolism - epidemiology; Thromboembolism - physiopathology; Vascular diseases and vascular malformations of the nervous system; Stroke; Thromboembolism; Atrial fibrillation; Risk stratification; Scheme; Arrhythmia; Cardiovascular disease; Risk; Vascular disease; Heart disease; Cardiology; Stratification; Cerebrovascular disease; Human; Nervous system diseases; Prediction; Patient; Test reliability; Thrombosis; Excitability disorder; Embolism; Cerebral disorder; Test validation; Central nervous system disease; Risk factor; Predictive factor; Comparative study
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2011.10.096

Abstract Background The risk of thromboembolic (TE) complications in atrial fibrillation (AF) patients is not homogeneous. Risk schemes can help target anticoagulant therapy for patients at highest risk of TE complications. Objectives To test the predictive ability of 4 risk schemes: The Framingham, the 8th ACCP, the ACC/AHA/ESC 2006, and the CHA2 DS2 -VASc. Methods 186 patients with non-valvular AF and off anticoagulant therapy were included. All subjects who experienced a stroke, transient ischemic attack, or peripheral embolism were identified. Each schema was divided into low, intermediate, and high-risk categories. Discrimination was assessed via the c-statistic. Results We identified 10 TE events that occurred during 668 person-years off anticoagulation therapy. All risk schemes had fair discriminating ability (c-statistic ranged from 0.59 [for CHA2 DS2 -VASc] to 0.73 [for Framingham]). The proportion of patients assigned to individual risk categories varied widely across schemes. CHA2 DS2 -VASc categorized the fewest patients into low and intermediate-risk categories, whereas the Framingham schema assigned the highest patients into low-risk strata. There were no TE events in the low and intermediate-risk categories using CHA2 DS2 -VASc, whereas the most schemes assigned patients into intermediate-risk category had a event rate ranging from 2.5 (ACC/AHA/ESC and 8th ACCP schemes) to 6% (Framingham). The negative predictive value of TE events was of 100% for the no high-risk patients using CHA2 DS2 -VASc. Conclusions Compared to ACC/AHA/ESC, 8th ACCP, and Framingham, CHA2 DS2 -VASc risk stratification schema may be better in discriminating between patients at a low and intermediate risk of TE complications.