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 Ialian patents 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% patents. 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 pedictive value of CHA2DS2-VASc score for stroke.

Carotid plaque detection improves the predictve value of CHA2DS2-VASc score in patients with non-valvular atrial fibrilation: The ARAPACIS Study

Averna, M.;Mule, G.;Malatino, L.;Pinto, A.;Signorelli, S.;Fazio, V.;De Luca, N.;Abate, D.;Castellino, P.;Zanoli, L.;Fidone, F.;Arturi, F.;Maio, R.;De Luca, E.;Castagna, A.;Spinelli, D.;Casella, G.;Picardi, A.;Delfino, M.;Giorgi, A.;Sacco, A.;Caruso, A. A.;Bellanuova, I.;Galasso, S.;Porta, M.;D'Angelo, A.;Ferro, D.;Butta, C.;Pesce, P.;Scicali, R.;Vecchio, C. R.;
2017-01-01

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 Ialian patents 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% patents. 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 pedictive value of CHA2DS2-VASc score for stroke.
2017
Atherosclerosis; Atrial fibrillation; Carotid plaque; CHA2DS2-VASc score; Stroke; Vascular disease; Aged; Aged, 80 and over; Ankle Brachial Index; Atrial Fibrillation; Carotid Artery Diseases; Female; Humans; Incidence; Italy; Male; Plaque, Atherosclerotic; Retrospective Studies; Risk Factors; Survival Rate; Ultrasonography, Doppler; Risk Assessment; Cardiology and Cardiovascular Medicine
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/328981
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