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

The ARAPACIS Study

Stefania Basili, Lorenzo Loffredo, Daniele Pastori, Marco Proietti, Alessio Farcomeni, Anna Rita Vestri, Pasquale Pignatelli, Giovanni Davì, William R. Hiatt, Gregory Y.H. Lip, Gino R. Corazza, Francesco Perticone, Francesco Violi, in collaboration with ARAPACIS Study Investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)143-149
Number of pages7
JournalInternational Journal of Cardiology
Volume231
DOIs
Publication statusPublished - Mar 15 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

  • Atherosclerosis
  • Atrial fibrillation
  • Carotid plaque
  • CHADS-VASc score
  • Stroke
  • Vascular disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Basili, S., Loffredo, L., Pastori, D., Proietti, M., Farcomeni, A., Vestri, A. R., ... in collaboration with ARAPACIS Study Investigators (2017). Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation: The ARAPACIS Study. International Journal of Cardiology, 231, 143-149. https://doi.org/10.1016/j.ijcard.2017.01.001

Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation : The ARAPACIS Study. / Basili, Stefania; Loffredo, Lorenzo; Pastori, Daniele; Proietti, Marco; Farcomeni, Alessio; Vestri, Anna Rita; Pignatelli, Pasquale; Davì, Giovanni; Hiatt, William R.; Lip, Gregory Y.H.; Corazza, Gino R.; Perticone, Francesco; Violi, Francesco; in collaboration with ARAPACIS Study Investigators.

In: International Journal of Cardiology, Vol. 231, 15.03.2017, p. 143-149.

Research output: Contribution to journalArticle

Basili, S, Loffredo, L, Pastori, D, Proietti, M, Farcomeni, A, Vestri, AR, Pignatelli, P, Davì, G, Hiatt, WR, Lip, GYH, Corazza, GR, Perticone, F, Violi, F & in collaboration with ARAPACIS Study Investigators 2017, 'Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation: The ARAPACIS Study', International Journal of Cardiology, vol. 231, pp. 143-149. https://doi.org/10.1016/j.ijcard.2017.01.001
Basili, Stefania ; Loffredo, Lorenzo ; Pastori, Daniele ; Proietti, Marco ; Farcomeni, Alessio ; Vestri, Anna Rita ; Pignatelli, Pasquale ; Davì, Giovanni ; Hiatt, William R. ; Lip, Gregory Y.H. ; Corazza, Gino R. ; Perticone, Francesco ; Violi, Francesco ; in collaboration with ARAPACIS Study Investigators. / Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation : The ARAPACIS Study. In: International Journal of Cardiology. 2017 ; Vol. 231. pp. 143-149.
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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.",
keywords = "Atherosclerosis, Atrial fibrillation, Carotid plaque, CHADS-VASc score, Stroke, Vascular disease",
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T1 - Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation

T2 - The ARAPACIS Study

AU - Basili, Stefania

AU - Loffredo, Lorenzo

AU - Pastori, Daniele

AU - Proietti, Marco

AU - Farcomeni, Alessio

AU - Vestri, Anna Rita

AU - Pignatelli, Pasquale

AU - Davì, Giovanni

AU - Hiatt, William R.

AU - Lip, Gregory Y.H.

AU - Corazza, Gino R.

AU - Perticone, Francesco

AU - Violi, Francesco

AU - in collaboration with ARAPACIS Study Investigators

PY - 2017/3/15

Y1 - 2017/3/15

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.

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.

KW - Atherosclerosis

KW - Atrial fibrillation

KW - Carotid plaque

KW - CHADS-VASc score

KW - Stroke

KW - Vascular disease

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