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
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References
- A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference.Europace. 2016; 18: 37-50
- Stroke prevention in atrial fibrillation: a systematic review.JAMA. 2015; 313: 1950-1962
- Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.Lancet. 2014; 383: 955-962
- Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: implications for risk and therapy.J. Am. Coll. Cardiol. 2013; 62: 2255-2256
- Incidence of myocardial infarction and vascular death in elderly patients with atrial fibrillation taking anticoagulants: relation to atherosclerotic risk factors.Chest. 2015; 147: 1644-1650
- Thromboembolism or atherothromboembolism in atrial fibrillation?.Circ. Arrhythm. Electrophysiol. 2012; 5: 1053-1055
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.Chest. 2010; 137: 263-272
- Ankle-brachial index and cardiovascular events in atrial fibrillation: ARAPACIS prospective study.Thromb. Haemost. 2016; 115: 856-863
- Medication prescription and adherence disparities in non valvular atrial fibrillation patients: an Italian portrait from the ARAPACIS study.Intern. Emerg. Med. 2014; 9: 861-870
- Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine.J. Am. Soc. Echocardiogr. 2008; 21: 93-111
- Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers.Stat. Med. 2011; 30: 11-21
- Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers.BMC Med. Inform. Decis. Mak. 2008; 8: 53
- Time-dependent ROC curves for censored survival data and a diagnostic marker.Biometrics. 2000; 56: 337-344
- Relationship between carotid intima-media thickness and non valvular atrial fibrillation type.Atherosclerosis. 2015; 238: 350-355
- Carotid atherosclerosis and stroke in atrial fibrillation: the Atherosclerosis Risk in Communities Study.Stroke. 2016; 47: 1643-1646
- Statins as antithrombotic drugs.Circulation. 2013; 127: 251-257
- The Net Reclassification Index (NRI): a misleading measure of prediction improvement even with independent test data sets.Stat. Biosci. 2015; 7: 282-295
Article info
Publication history
Published online: January 04, 2017
Accepted:
January 2,
2017
Received in revised form:
December 21,
2016
Received:
October 26,
2016
Identification
Copyright
© 2017 Published by Elsevier Ireland Ltd.
