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Heart Rhythm. 2014 Oct;11(10):1752-9. doi: 10.1016/j.hrthm.2014.06.021. Epub 2014 Jun 18.

Incidence and prediction of ischemic stroke among atrial fibrillation patients with end-stage renal disease requiring dialysis.

Author information

  • 1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
  • 2Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
  • 3Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
  • 4University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
  • 5Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: epsachen@ms41.hinet.net.

Abstract

BACKGROUND:

Renal dysfunction is a significant risk factor for ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence among AF patients with end-stage renal disease (ESRD) are unclear.

OBJECTIVE:

The purpose of this study was to compare the CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in AF patients with ESRD.

METHODS:

A total of 10,999 AF patients with ESRD undergoing renal replacement therapy who were not receiving oral anticoagulants or antiplatelet agents were identified from Taiwan's National Health Insurance Research Database. The study end-point was occurrence of ischemic stroke.

RESULTS:

The median (interquartile) CHADS2 and CHA2DS2-VASc scores for the study cohort were 3 (2-5) and 5 (4-7), respectively. During follow-up, 1217 patients (11.7%) experienced ischemic stroke, with an incidence rate of 6.9 per 100 person-years. In Cox regression models, the CHADS2 and CHA2DS2-VASc scores both were significant predictors of ischemic stroke. C-indexes for CHADS2 and CHA2DS2-VASc were 0.608 and 0.682, respectively (P < .001). CHA2DS2-VASc improved the net reclassification index by 4.8% compared with CHADS2 (P < .0001). Among 1409 patients with a CHADS2 score of 0 or 1, the CHA2DS2-VASc score ranged from 1 to 4, with event rates ranging from 2.1 to 4.7 per 100 person-years.

CONCLUSION:

The CHA2DS2-VASc score was useful in predicting ischemic stroke in AF patients with ESRD undergoing dialysis and was superior to the CHADS2 score. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high-risk patients remains to be defined.

Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Atrial fibrillation; CHA(2)DS(2)-VASc score; CHADS(2) score; End-stage renal disease; Ischemic stroke

PMID:
24952148
[PubMed - indexed for MEDLINE]
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