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Title: The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention.
Austin Authors: Parfrey, Shane;Teh, Andrew W ;Roberts, Louise;Brennan, Angela;Clark, David J ;Duffy, Stephen J;Ajani, Andrew E;Reid, Christopher M;Freeman, Melanie
Affiliation: Department of Cardiology, Box Hill Hospital
Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University
University of Melbourne, Melbourne, Australia
Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Centre for Clinical Research and Education, and WAHTN Clinical Trials and Data Management Centre, Curtain University, Perth, Western Australia, Australia
Issue Date: 2021
Date: 2020-12-23
Publication information: Coronary Artery Disease 2021; 32(4): 288-294
Abstract: The aim of the review was to assess whether CHA2DS2-VASc score is predictive of mortality in patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI). The CHA2DS2-VASc score is validated in predicting stroke risk in atrial fibrillation. The optimum management strategy for these patients undergoing PCI is still debated. The CHA2DS2-VASc score was calculated in consecutive patients with atrial fibrillation undergoing PCI in a large Australian registry between 2007 and 2013. Patients were divided into low (1-2), intermediate (3-4) and high (≥5) groups. Clinical and procedural data, 30-day, 1-year and long-term outcomes were compared between the groups. A total of 564 patients were included in our analysis. Patients with high CHA2DS2-VASc scores had higher mortality rates at 1-year (2, 8, 15; P = 0.002) and long-term (6, 20, 37; P < 0.001). High-risk patients were more likely to have renal impairment and multivessel disease. Increasing CHA2DS2-VASc score was associated with increased risk of stroke (0, 2, 6; P = 0.03). However, only 41.9% received anticoagulation, with no difference across the risk groups. When compared to low-risk, intermediate [HR 3.57; 95% confidence interval (CI), 1.28-9.92; P = 0.015] and high (hazard ratio 7.82; 95% CI, 2.88-21.24; P < 0.001) CHA2DS2-VASc scores were significant predictors of long-term mortality. Higher CHA2DS2-VASc scores in patients with atrial fibrillation undergoing PCI are associated with significantly worse outcomes. Despite being high-risk, the patients in this cohort are likely undertreated with anticoagulation. Close clinical follow-up with greater utilization of anticoagulation and optimal medical therapy has the potential to improve long-term outcomes.
DOI: 10.1097/MCA.0000000000000987
Journal: Coronary Artery Disease
PubMed URL: 33394696
Type: Journal Article
Appears in Collections:Journal articles

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