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Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical
Amaya García-Fernández1, Francisco Marín, Vanessa Roldán
1Arrhythmia Unit, Department of Cardiology, General University Hospital of Alicante.
Insights
Long-term anticoagulation quality and adherence are crucial after electrical cardioversion for atrial fibrillation (AF) to prevent thromboembolic events (TE). The CHA2DS2-VASc score offers superior prediction of TE compared to the CHADS2 score in AF patients undergoing ECV.
Area of Science:
- Cardiology
- Thrombosis Research
- Atrial Fibrillation Management
Background:
- Patients undergoing electrical cardioversion (ECV) for nonvalvular atrial fibrillation (AF) are often younger with fewer comorbidities.
- Long-term anticoagulation post-ECV is essential and should be guided by thromboembolic risk assessment.
Purpose of the Study:
- To investigate the long-term incidence of thromboembolic events (TE) after ECV in nonvalvular AF patients.
- To identify factors associated with TE in this population.
- To compare the predictive performance of CHADS2 and CHA2DS2-VASc scores for TE post-ECV.
Main Methods:
- A cohort of 406 patients with nonvalvular AF undergoing 571 ECV procedures between January 2008 and June 2012 was studied.
- Data on risk factors for TE and anticoagulation therapy post-ECV were collected.
- Follow-up was approximately 2 years to assess TE incidence and analyze predictive scores.
Main Results:
- The annual incidence of TE was 1.9% over a 2-year follow-up.
- Factors significantly associated with TE included poor anticoagulation control (HR: 2.91), cessation of anticoagulation (HR: 8.80), age ≥65 years (HR: 13.65), CHADS2 score (HR: 1.59), and CHA2DS2-VASc score (HR: 1.67).
- The CHA2DS2-VASc score demonstrated superior predictive accuracy (c-statistic: 0.75) compared to the CHADS2 score (c-statistic: 0.68).
Conclusions:
- Anticoagulant therapy quality and adherence are critical determinants of long-term TE occurrence post-ECV.
- The CHA2DS2-VASc score is a reliable predictor of TE after ECV, outperforming the CHADS2 score.
Background:
Patients with nonvalvular atrial fibrillation (AF) who undergo electrical cardioversion (ECV) tend to be younger and have less comorbidity. Long-term anticoagulation after ECV should be based on thromboembolic risk. We sought to study the long-term incidence of thromboembolic events (TE), factors related to TE and compare the predictive value of the CHADS2and CHA2DS2-VASc scores in this particular population.
Methods And Results:
From January 2008 to June 2012, 571 ECV were performed in 406 consecutive patients with nonvalvular AF. Risk factors for TE and factors related to anticoagulation therapy after ECV were registered. During a follow-up of approximately 2 years, the annual incidence of TE was 1.9%. Factors associated with TE were: poor quality anticoagulation control (hazard ratio [HR]: 2.91; 95% confidence interval [CI]: 1.10-7.80; P=0.03), cessation of anticoagulation after ECV (HR: 8.80; 95% CI: 3.11-25.10; P<0.001), age ≥65 years (HR: 13.65; 95% CI: 1.74-107.16; P=0.01), CHADS2score (HR: 1.59; 95% CI: 1.10-2.29; P=0.01) and CHA2DS2-VASc score (HR: 1.67; 95% CI: 1.30-2.22; P<0.001). Both risk scores predicted TE [c-statistic for CHADS2: 0.68 (95% CI: 0.62-0.74; P=0.005), for CHA2DS2-VASc: 0.75 (95% CI: 0.70-0.80; P<0.001)]. Based on c-statistics, the predictive accuracy of CHA2DS2-VASc was superior (difference between areas: 0.064±0.031; P=0.0403).
Conclusions:
Important determinants of long-term occurrence of TE after ECV were related to anticoagulant therapy (poor quality anticoagulation and cessation of this therapy over follow-up). The CHA2DS2-VASc score successfully predicts TE after ECV, having better predictive accuracy than the CHADS2score. (Circ J 2016; 80: 605-612).
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