Adverse cardiovascular outcomes in atrial fibrillation: Validation of the new 2MACE risk score

M. Polovina, D. Đikić, A. Vlajković, M. Vilotijević, I. Milinković, M. Ašanin, M. Ostojić, A.J.S. Coats, P.M. Seferović

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Background In addition to thromboembolism, atrial fibrillation (AF) may also predispose to major adverse cardiovascular events (MACE) attributable to coronary artery disease (CAD), including myocardial infarction (MI). The 2MACE score (2 points - Metabolic syndrome and Age ≥ 75 years, 1 point - MI/revascularization, Congestive heart failure/ejection-fraction <40%, and thrombo-Embolism) was recently proposed to help identify AF patients at risk of MACE. We assessed the predictive validity of the 2MACE score for MACE occurrence in AF patients free of CAD at baseline. Methods Non-valvular AF patients (n = 794) without CAD (mean-age, 62.5 ± 12.1 years, metabolic syndrome, 34.0%; heart failure/ejection-fraction <40%, 25.7%; thromboembolism, 9.7%) were prospectively followed for 5 years, or until MACE (composite of non-fatal/fatal MI, revascularization and cardiovascular death). At inclusion, CAD was excluded by medical history, exercise-stress testing and/or coronary angiography. Also, the 2MACE score was determined. Results At follow-up, 112 patients experienced MACE (2.8%/year). The 2MACE score demonstrated adequate discrimination (C-statistic, 0.699; 95% confidence interval [CI], 0.648–0.750; P <0.001) and calibration (Hosmer-Lemeshow P = 0.79) for MACE. The score was significantly associated with MACE, with the adjusted Hazard Ratio (aHR) of 1.56 (95%CI, 1.35–1.73; P <0.001). As for individual outcomes, the score predicted MI (n = 46; aHR, 1.49; 95%CI 1.23–1.80), revascularization (n = 32; aHR, 1.41; 95%CI, 1.11–1.80) and cardiovascular death (n = 34; aHR, 1.43; 95%CI, 1.14–1.81), all P <0.001. Conclusions The 2MACE score successfully predicts future MACE, including incident MI, coronary revascularization and cardiovascular death in AF patients free of CAD at baseline. It may have a role in risk-stratification and primary prevention of MACE in AF patients. © 2017 Elsevier Ireland Ltd
Original languageEnglish
Pages (from-to)191-197
Number of pages7
JournalInternational Journal of Cardiology
Publication statusPublished - 2017


  • 2MACE score
  • adult
  • age
  • aged
  • anamnesis
  • aortic valve disease
  • Article
  • atrial fibrillation
  • cardiovascular disease assessment
  • cerebrovascular accident
  • CHA2DS2-VASc score
  • chronic kidney failure
  • chronic obstructive lung disease
  • cohort analysis
  • comorbidity
  • congestive heart failure
  • coronary angiography
  • coronary artery bypass surgery
  • diabetes mellitus
  • diagnostic test accuracy study
  • exercise test
  • female
  • follow up
  • heart ejection fraction
  • heart infarction
  • heart muscle revascularization
  • human
  • hypertension
  • hypertriglyceridemia
  • major adverse cardiac event
  • major clinical study
  • male
  • metabolic syndrome X
  • middle aged
  • mitral valve disease
  • obesity
  • observational study
  • percutaneous coronary intervention
  • peripheral occlusive artery disease
  • predictive validity
  • priority journal
  • prognosis
  • risk assessment
  • sensitivity and specificity
  • thromboembolism
  • transient ischemic attack
  • validation study
  • very elderly
  • young adult


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