Abstract
Background and aims Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA2DS2-VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA2DS2-VASc score. Methods We analysed data from the ARAPACIS study, an observational study including 2027 Italian patients with non-valvular AF, in whom CP was detected using Doppler Ultrasonography. Results VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patients. Adding CP to the VD definition leaded to higher VD prevalence (30.9%). During a median [IQR] follow-up time of 36 months, 56 (2.8%) stroke/TIA events were recorded. Survival analysis showed that conventional VD alone did not increase the risk of stroke (Log-Rank: 0.009, p = 0.924), while addition of CP to conventional VD was significantly associated to an increased risk of stroke (LR: 5.730, p = 0.017). Cox regression analysis showed that VD + CP was independently associated with stroke (HR: 1.78, 95% CI: 1.05–3.01, p = 0.0318). Reclassification analysis showed that VD + CP allowed a significant risk reclassification when compared to VD alone in predicting stroke at 36 months (NRI: 0.192, 95% CI: 0.028–0.323, p = 0.032). Conclusions In non-valvular AF patients the addition of ultrasound detection of carotid plaque to conventional VD significantly increases the predictive value of CHA2DS2-VASc score for stroke. © 2017
Original language | English |
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Pages (from-to) | 143-149 |
Number of pages | 7 |
Journal | International Journal of Cardiology |
Volume | 231 |
DOIs | |
Publication status | Published - 2017 |
Keywords
- adult
- age
- Article
- atrial fibrillation
- cardiovascular disease
- cardiovascular disease assessment
- cardiovascular risk
- carotid atherosclerosis
- cerebrovascular accident
- CHA2DS2 VASc score
- comorbidity
- controlled study
- disease association
- event free survival
- female
- follow up
- gender
- human
- Italian (citizen)
- major clinical study
- male
- medical history
- middle aged
- observational study
- post hoc analysis
- predictive value
- prevalence
- retrospective study
- risk assessment
- risk factor
- survival analysis
- transient ischemic attack
- aged
- ankle brachial index
- atherosclerotic plaque
- carotid artery disease
- clinical trial
- complication
- Doppler ultrasonography
- incidence
- Italy
- multicenter study
- procedures
- survival rate
- trends
- very elderly, Aged
- Aged, 80 and over
- Ankle Brachial Index
- Atrial Fibrillation
- Carotid Artery Diseases
- Female
- Humans
- Incidence
- Male
- Plaque, Atherosclerotic
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Survival Rate
- Ultrasonography, Doppler