Albuminuria improves R 2 CHA 2 DS 2 -VASc score in predicting mortality in high cardiovascular risk population.

Autor: Piscitelli P; Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy. Electronic address: ap.piscitelli@operapadrepio.it., D'Errico MM; Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy., Vigna C; Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy., Marchese N; Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy., Lamacchia O; Unit of Endocrinology, University of Foggia, Foggia, FG, Italy., Fontana A; Biostatistics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy., Copetti M; Biostatistics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy., Pontremoli R; Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy., Mirijello A; Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy., De Cosmo SA; Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy. Electronic address: s.decosmo@operapadrepio.it.
Jazyk: angličtina
Zdroj: Nutrition, metabolism, and cardiovascular diseases : NMCD [Nutr Metab Cardiovasc Dis] 2023 Aug; Vol. 33 (8), pp. 1591-1598. Date of Electronic Publication: 2023 May 13.
DOI: 10.1016/j.numecd.2023.05.014
Abstrakt: Background and Aims: The CHA 2 DS 2 -VASc score estimates the risk of cardioembolism in patients with atrial fibrillation (AF). It also predicts vascular events and death in different clinical settings, even in the absence of AF. The R 2 CHA 2 DS 2 -VASc score, obtained by adding the glomerular filtration rate to CHA 2 DS 2 -VASc, shows a higher prediction ability for new events and all-cause mortality. The present study aims to assess whether the addition of albuminuria to R 2 CHA 2 DS 2 -VASc score further improves its discrimination ability in predicting all-cause mortality in a sample of high cardiovascular risk population.
Methods and Results: Prospective, monocentric, observational study, evaluating a subset of 737 subjects consecutively undergoing to coronary angiography at Coronary Unit of Scientific Institute "Casa Sollievo della Sofferenza" from June 2016 to December 2018. The presence of albuminuria was significantly associated with all-cause mortality (p < 0.0001). Any one-point increase of Alb-R 2 CHA 2 DS 2 -VASc score increased mortality of about 1.5-fold (adjusted HR 1.49; 95%CI: 1.37-1.63; p < 0.0001). Considering tertiles of Alb-R 2 CHA 2 DS 2 -VASc, the third tertile showed a 9.5-fold increased risk of mortality (HR 9.52; 95% CI: 5.15-17.60, p < 0.001). Comparing the two scores, the Alb-R 2 CHA 2 DS 2 -VASc score (C-statistic = 0.751; 95%CI: 0.69-0.81) outperformed the R 2 -CHA 2 DS 2 -VASc score (C-statistic = 0.736; 95%CI: 0.68-0.961) in predicting mortality (delta C-statistic = 0.015; 95%CI: 0.001-0.029). The better prediction ability of the Alb-R 2 CHA 2 DS 2 -VASc score was also proven by an IDI of 0.024 (p < 0.0001) and a relative IDI of 24.11% (p < 0.0001), with an NRI = 0.608 (p < 0.00001).
Conclusions: The addition of albuminuria to R 2 CHA 2 DS 2 -VASc significantly and independently predicts the risk of all-cause mortality in a sample of high CV risk patients. Moreover, Alb-R 2 CHA 2 DS 2 -VASc outperforms R 2 CHA 2 DS 2 -VASc.
Competing Interests: Declaration of competing interest The authors declare they have no conflict of interest. The results presented in this article have not been published previously in whole or in part.
(Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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