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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

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Published on: February 26, 2013

Vascular disease and stroke risk in atrial fibrillation: a nationwide cohort study

Jonas Bjerring Olesen1, Gregory Y H Lip, Deirdre A Lane

  • 1Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. jo@heart.dk

The American Journal of Medicine
|May 15, 2012
PubMed

Insights

Vascular disease is an independent risk factor for stroke in atrial fibrillation patients. Adding vascular disease to the CHADS(2) score improves stroke risk prediction.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Atrial fibrillation increases stroke risk.
  • Vascular disease is a potential, though less validated, risk factor for stroke in atrial fibrillation.
  • The CHADS(2) score is a common tool for stratifying stroke risk in these patients.

Purpose of the Study:

  • To determine if vascular disease is an independent risk factor for stroke/thromboembolism in atrial fibrillation.
  • To assess if incorporating vascular disease into risk stratification improves upon the existing CHADS(2) score.

Main Methods:

  • Utilized nationwide Danish registers from 1997-2008.
  • Included patients with atrial fibrillation not on anticoagulation.
  • Employed Cox regression analyses and evaluated risk prediction improvement using Net Reclassification Improvement and Integrated Discrimination Improvement.

Main Results:

  • 17.4% of 87,202 atrial fibrillation patients had vascular disease.
  • Vascular disease independently increased stroke/thromboembolism risk (HR 1.12).
  • Peripheral artery disease posed a higher risk than myocardial infarction alone; vascular disease significantly improved CHADS(2) score predictive ability.

Conclusions:

  • Vascular disease is a significant independent predictor of stroke/thromboembolism in atrial fibrillation.
  • The inclusion of vascular disease enhances the predictive accuracy of the CHADS(2) score for stroke risk stratification.
Abstract

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