The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention
Objective 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). Background The CHA2DS2-VASc score is validated in predicting stroke risk in atrial fibrillation. The optimum m...
| Main Authors: | , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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LIPPINCOTT WILLIAMS & WILKINS
2021
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93759 |
| _version_ | 1848765781524873216 |
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| author | Parfrey, S. Teh, A.W. Roberts, L. Brennan, A. Clark, D. Duffy, S.J. Ajani, A.E. Reid, Christopher Freeman, M. |
| author_facet | Parfrey, S. Teh, A.W. Roberts, L. Brennan, A. Clark, D. Duffy, S.J. Ajani, A.E. Reid, Christopher Freeman, M. |
| author_sort | Parfrey, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Objective 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). Background 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. Methods 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. Results 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. Conclusions: 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. |
| first_indexed | 2025-11-14T11:40:42Z |
| format | Journal Article |
| id | curtin-20.500.11937-93759 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:40:42Z |
| publishDate | 2021 |
| publisher | LIPPINCOTT WILLIAMS & WILKINS |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-937592024-01-09T07:24:40Z The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention Parfrey, S. Teh, A.W. Roberts, L. Brennan, A. Clark, D. Duffy, S.J. Ajani, A.E. Reid, Christopher Freeman, M. Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology atrial fibrillation CHA(2)DS(2)-VASc percutaneous coronary intervention stroke MYOCARDIAL-INFARCTION ANTITHROMBOTIC THERAPY STENT IMPLANTATION TRIPLE THERAPY RISK OUTCOMES STROKE ANTICOAGULATION PREDICTORS MORTALITY Aged Atrial Fibrillation Australia Female Humans Male Middle Aged Organ Dysfunction Scores Percutaneous Coronary Intervention Registries Risk Assessment Stroke Humans Atrial Fibrillation Registries Risk Assessment Aged Middle Aged Australia Female Male Stroke Organ Dysfunction Scores Percutaneous Coronary Intervention Objective 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). Background 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. Methods 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. Results 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. Conclusions: 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. 2021 Journal Article http://hdl.handle.net/20.500.11937/93759 10.1097/MCA.0000000000000987 English http://purl.org/au-research/grants/nhmrc/1111170 LIPPINCOTT WILLIAMS & WILKINS restricted |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology atrial fibrillation CHA(2)DS(2)-VASc percutaneous coronary intervention stroke MYOCARDIAL-INFARCTION ANTITHROMBOTIC THERAPY STENT IMPLANTATION TRIPLE THERAPY RISK OUTCOMES STROKE ANTICOAGULATION PREDICTORS MORTALITY Aged Atrial Fibrillation Australia Female Humans Male Middle Aged Organ Dysfunction Scores Percutaneous Coronary Intervention Registries Risk Assessment Stroke Humans Atrial Fibrillation Registries Risk Assessment Aged Middle Aged Australia Female Male Stroke Organ Dysfunction Scores Percutaneous Coronary Intervention Parfrey, S. Teh, A.W. Roberts, L. Brennan, A. Clark, D. Duffy, S.J. Ajani, A.E. Reid, Christopher Freeman, M. The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention |
| title | The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention |
| title_full | The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention |
| title_fullStr | The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention |
| title_full_unstemmed | The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention |
| title_short | The role of CHA2DS2-VASc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention |
| title_sort | role of cha2ds2-vasc score in evaluating patients with atrial fibrillation undergoing percutaneous coronary intervention |
| topic | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology atrial fibrillation CHA(2)DS(2)-VASc percutaneous coronary intervention stroke MYOCARDIAL-INFARCTION ANTITHROMBOTIC THERAPY STENT IMPLANTATION TRIPLE THERAPY RISK OUTCOMES STROKE ANTICOAGULATION PREDICTORS MORTALITY Aged Atrial Fibrillation Australia Female Humans Male Middle Aged Organ Dysfunction Scores Percutaneous Coronary Intervention Registries Risk Assessment Stroke Humans Atrial Fibrillation Registries Risk Assessment Aged Middle Aged Australia Female Male Stroke Organ Dysfunction Scores Percutaneous Coronary Intervention |
| url | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93759 |