Abstract 12001: AFCAS, a Prospective Multicenter Registry of Patients with Atrial Fibrillation Undergoing Coronary Artery Stenting: Comparison of Chads2- with Cha2ds2-vasc Score
Background Current European guidelines on the management of patients with atrial fibrillation (AF) recommend the use of the new CHA2DS2-VASc score to complement the simple CHADS2 score to assist stroke risk stratification. It is uncertain how the CHA2DS2-VASc score may influence treatment of patients with AF in daily clinical practice.
Methods AFCAS (Management of patients with Atrial Fibrillation undergoing Coronary Artery Stenting) is a multicenter European prospective registry, which recruited patients with AF undergoing percutaneous coronary intervention/stenting (PCI-S) (ClinicalTrials.gov Identifier: NCT00596570). The aim of this study was to register data regarding current standard medical therapy of this condition and to define the efficacy and safety of various treatment options. We analysed the impact of the CHADS2 and the new CHA2DS2-VASc score in the AFCAS-population.
Results 17 centers from 5 European countries participated. For this substudy, data from 963 patients (age 73.0±8.2 years, BMI 28.2±4.5kg/m2, 29.9% female, 36.3% diabetic and 84.1% hypertensive) were analysed. Indication for PCI-S was mostly acute coronary syndrome (56.5%), and stent type was mostly BMS (56.6%). The CHADS2-score was ≥2 in 72.1% (group 1), CHADS2=1 in 23.2% (group 2), and CHADS2=0 in 4.7% 0 (group 3). In group 1, all patients had a CHA2DS2-VASc-Score ≥2 (indication for VKA treatment according to both scores). In group 2, in which aspirin or VKA was recommended according to the CHADS2-score, all patients had a CHA2DS2-VASc score ≥2 (VKA recommended). In group 3, in which no VKA would be recommended according to the established CHADS2-score, a CHA2DS2-VASc-score=1 was found in 15.1% (VKA recommended, aspirin possible) but in all other patients CHA2DS2-VASc- score was ≥2 (VKA recommended).
Conclusions In patients with AF undergoing PCI-S in the prospective, multicenter AFCAS registry, the CHADS2-score may underestimate requirement for VKA - as compared to the new CHA2DS2-VASc-score. This latter would alter treatment of patients with AF by categorizing more patients as high risk for stroke with an indication for VKA-treatment. This is of major importance for patients after PCI-S, since more patients will require triple therapy post-procedure.
- © 2011 by American Heart Association, Inc.