Arterial Thromboembolism in Patients With Atrial Fibrillation and CHA 2 DS 2 -VASc Score 1: A Nationwide Study.

Autor: Østergaard L; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark., Olesen JB; Department of Cardiology, Herlev-Gentofte Hospital (J.B.O., M.S.), University of Copenhagen, Denmark., Petersen JK; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark., Nielsen LS; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark., Kristensen SL; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark., Schou M; Department of Cardiology, Herlev-Gentofte Hospital (J.B.O., M.S.), University of Copenhagen, Denmark., Køber L; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark., Fosbøl E; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Circulation [Circulation] 2024 Mar 05; Vol. 149 (10), pp. 764-773. Date of Electronic Publication: 2023 Dec 28.
DOI: 10.1161/CIRCULATIONAHA.123.066477
Abstrakt: Background: Oral anticoagulation is suggested in patients with atrial fibrillation and a CHA 2 DS 2 -VASc score ≥1 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, and sex score). To assess granular differences within CHA 2 DS 2 -VASc 1, the incidence of arterial thromboembolism according to CHA 2 DS 2 -VASc 1 subgroups was examined.
Methods: The Danish National Patient Registry and the Danish Prescription Registry were linked on a nationwide level to identify patients with atrial fibrillation from 2000 to 2021 without oral anticoagulation and categorized according to CHA 2 DS 2 -VASc score: CHA 2 DS 2 -VASc 0 (male and female subjects); CHA 2 DS 2 -VASc 1 (hypertension, heart failure, diabetes, vascular disease, and age 65-74 years); or CHA 2 DS 2 -VASc 2 (age ≥75 years without other risk factors). Female sex was not considered a risk factor in any risk group. The outcome was arterial thromboembolism (ischemic stroke, embolism of extremity, or transient cerebral ischemia). Study groups were compared using Cox regression analysis.
Results: We included 26 701 patients with a CHA 2 DS 2 -VASc 0 score; 22 915 with CHA 2 DS 2 -VASc 1 (1483 patients with heart failure, 9066 with hypertension, 843 with diabetes, 770 with vascular disease, and 10 753 who were 65 to 74 years of age); and 14 525 patients with CHA 2 DS 2 -VASc 2 (≥75 years of age without other risk factors). With a median of 1 year of observation time, the cumulative incidence of arterial thromboembolism was 0.6% (n=154 [95% CI, 0.6%-0.8%]), 1.4% (n=16 [95% CI, 0.8%-2.2%]), 1.9% (n=141 [95% CI, 1.6%-2.2%]), 1.7% (n=12 [95% CI, 0.9%-2.9%]), 2.0% (n=13 [95% CI, 1.1%-3.4%]), 2.3% (n=187 [95% CI, 2.0%-2.7%]), and 4.4% (n=533 [95% CI, 4.1%-4.8%]) for CHA 2 DS 2 -VASc 0, heart failure, hypertension, diabetes, vascular disease, age 65 to 74 years (CHA 2 DS 2 -VASc 1), and age ≥75 years (CHA 2 DS 2 -VASc 2), respectively. No statistically significant difference was identified among subgroups of CHA 2 DS 2 -VASc 1 ( P =0.15 for difference).
Conclusions: For patients with atrial fibrillation, all subgroups of CHA 2 DS 2 -VASc 1 were associated with lower incidence of arterial thromboembolism compared with age ≥75 years without other risk factors (ie, CHA 2 DS 2 -VASc 2) and a higher incidence compared with CHA 2 DS 2 -VASc 0. No statistically significant difference was identified between the subgroups of CHA 2 DS 2 -VASc 1. These findings support current recommendations that patients within this intermediate risk group could be identified with a similar risk of arterial thromboembolism.
Competing Interests: Disclosures L.Ø. declares an independent research grant related to research in mitral valve regurgitation from the Novo Nordisk Foundation. J.B.O. declares speaker honoraria or consultancy fees from Bayer, Bristol-Myers Squibb, and Pfizer. S.L.K. declares speaker fees from AstraZeneca and advisory board membership for Bayer, not related to the present work. M.S. declares lecture fees from Novartis, Novo, AstraZeneca, and Boehringer. L.K. declares speaker honoraria from Astra Zeneca, Bayer, Boehringer, Novartis, and Novo. E.L.F. declares an independent research grant related to valvular heart disease and endocarditis from the Novo Nordisk Foundation and the Danish Heart Association. The other authors report no conflicts.
Databáze: MEDLINE
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