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


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
Publication statusPublished - 2017


  • 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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