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

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6 Citations (Scopus)

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

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Vascular Diseases
Atrial Fibrillation
Stroke
Doppler Ultrasonography
Peripheral Arterial Disease
Survival Analysis
Observational Studies
Atherosclerosis
Myocardial Infarction
Regression Analysis

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

Cite this

@article{53c8d61828df458183e13139ddf9995d,
title = "Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation: The ARAPACIS Study",
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. {\circledC} 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",
author = "S. Basili and L. Loffredo and D. Pastori and M. Proietti and A. Farcomeni and A.R. Vestri and P. Pignatelli and G. Dav{\`i} and W.R. Hiatt and G.Y.H. Lip and G.R. Corazza and F. Perticone and F. Violi and {ARAPACIS Study Investigators} and Marco Moia",
year = "2017",
doi = "10.1016/j.ijcard.2017.01.001",
language = "English",
volume = "231",
pages = "143--149",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation: The ARAPACIS Study

AU - Basili, S.

AU - Loffredo, L.

AU - Pastori, D.

AU - Proietti, M.

AU - Farcomeni, A.

AU - Vestri, A.R.

AU - Pignatelli, P.

AU - Davì, G.

AU - Hiatt, W.R.

AU - Lip, G.Y.H.

AU - Corazza, G.R.

AU - Perticone, F.

AU - Violi, F.

AU - ARAPACIS Study Investigators

AU - Moia, Marco

PY - 2017

Y1 - 2017

N2 - 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

AB - 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

KW - adult

KW - age

KW - Article

KW - atrial fibrillation

KW - cardiovascular disease

KW - cardiovascular disease assessment

KW - cardiovascular risk

KW - carotid atherosclerosis

KW - cerebrovascular accident

KW - CHA2DS2 VASc score

KW - comorbidity

KW - controlled study

KW - disease association

KW - event free survival

KW - female

KW - follow up

KW - gender

KW - human

KW - Italian (citizen)

KW - major clinical study

KW - male

KW - medical history

KW - middle aged

KW - observational study

KW - post hoc analysis

KW - predictive value

KW - prevalence

KW - retrospective study

KW - risk assessment

KW - risk factor

KW - survival analysis

KW - transient ischemic attack

KW - aged

KW - ankle brachial index

KW - atherosclerotic plaque

KW - carotid artery disease

KW - clinical trial

KW - complication

KW - Doppler ultrasonography

KW - incidence

KW - Italy

KW - multicenter study

KW - procedures

KW - survival rate

KW - trends

KW - very elderly, Aged

KW - Aged, 80 and over

KW - Ankle Brachial Index

KW - Atrial Fibrillation

KW - Carotid Artery Diseases

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Plaque, Atherosclerotic

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Survival Rate

KW - Ultrasonography, Doppler

U2 - 10.1016/j.ijcard.2017.01.001

DO - 10.1016/j.ijcard.2017.01.001

M3 - Article

VL - 231

SP - 143

EP - 149

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -