Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation: The ARAPACIS Study

ARAPACIS Study Investigators, Marco Moia

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
Pages (from-to)143-149
Number of pages7
JournalInternational Journal of Cardiology
Volume231
DOIs
Publication statusPublished - 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

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