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Stroke. 2014 Feb;45(2):426-31. doi: 10.1161/STROKEAHA.113.002585. Epub 2013 Dec 5.

Comparison of clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation.

Author information

1
From the Department of Internal Medicine (C.A.A.), Division of Cardiovascular Diseases (C.J.M., B.J.G.), and Section of Biostatistics (S.S.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, The University British Columbia, Vancouver, British Columbia, Canada (T.S.M.T.); and University Department of Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).

Abstract

BACKGROUND AND PURPOSE:

Several accepted algorithms exist to characterize the risk of thromboembolism in atrial fibrillation. We performed a comparative analysis to assess the predictive value of 9 such schemes.

METHODS:

In a longitudinal community-based cohort study from Olmsted County, Minnesota, 2720 residents with atrial fibrillation were followed up for 4.4±3.6 years±SD from 1990 to 2004. Risk factors were identified using a diagnostic index integrated with the electronic medical record. Thromboembolism and cardiovascular event data were collected and analyzed.

RESULTS:

We identified 350 validated thromboembolic events in our cohort. Multivariable analysis identified age >75 years (odds ratio, 2.08; P<0.0001), female sex (odds ratio, 1.45; P=0.0015), history of hypertension (odds ratio, 3.07; P<0.0001), diabetes mellitus (odds ratio, 1.58; P=0.0003), and history of heart failure (odds ratio, 1.50; P=0.0102) as significant predictors of clinical thromboembolism. The Stroke Prevention in Atrial Fibrillation (SPAF; hazard ratio, 2.75; c=0.659), CHADS2-revised (hazard ratio, 3.48; c=0.654), and CHADS2-classical (hazard ratio, 2.90; c=0.653) risk schemes were most accurate in risk stratification. The low-risk cohort within the CHA2DS2-VASc scheme had the lowest event rate among all low-risk cohorts (0.11 per 100 person-years).

CONCLUSIONS:

A direct comparison of 9 risk schemes reveals no profound differences in risk stratification accuracy for high-risk patients. Accurate prediction of low-risk patients is perhaps more valuable in determining those unlikely to benefit from oral anticoagulation therapy. Among our cohort, CHA2DS2-VASc performed best in this purpose.

KEYWORDS:

atrial fibrillation; stroke

PMID:
24309585
DOI:
10.1161/STROKEAHA.113.002585
[Indexed for MEDLINE]

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